Part 3: Endoscopic injection versus antibiotic prophylaxis in the reduction of urinary tract infections in patients with vesicoureteral reflux.
OBJECTIVE
Vesicoureteral reflux (VUR) occurs in approximately 1% of infants and children and is associated with recurrent urinary tract infections (UTIs). The objective of this paper is to examine the use of endoscopic injection with dextranomer/hyaluronic acid copolymer (Dx/HA) as a curative option and as an alternative to antibiotic prophylaxis, as Dx/HA is gaining in popularity in the treatment of VUR.


METHODS
The nationally representative PharMetrics Integrated Medical and Pharmaceutical database was used to conduct this retrospective analysis. Patients < 11 years of age who were continuously eligible and had an International Classification of Diseases (ICD-9-CM) code for VUR were identified. Resource utilization and outcome measures were evaluated over a 6-month pre- and 12-month post-index period. Patients diagnosed with neuropathic bladder, posterior urethral valves, bladder exstrophy, ureterocele, or duplication anomaly were excluded. Patients were matched 3 : 1, antibiotic prophylaxis to Dx/HA, by age, gender, urinary tract infections (UTIs) prior to index date, and diagnosing physician specialty. The primary outcome assessed was UTIs.


RESULTS
Of the matched patients, 114 received a prescription for antibiotic prophylaxis and 38 underwent endoscopic injection with Dx/HA between January 2000 and December 2004. The average number of UTIs per year was 0.28 in the antibiotic cohort and 0.08 in the Dx/HA cohort, respectively. The incidence rate ratio (IRR) of 4.826 (p = 0.029) revealed that the average number of UTIs was 383% higher for patients receiving antibiotic prophylaxis compared with patients who underwent endoscopic injection. The retrospective nature of the analysis did not allow for treatment randomization. Due to the stringent classification of UTIs, rates of UTIs may be underestimated in both cohorts.


CONCLUSIONS
Treatment with endoscopic injection with Dx/HA resulted in significantly fewer UTIs compared with children receiving antibiotic prophylaxis, supporting a role for Dx/HA as a first-line treatment option for patients with VUR.
Elder
Jack S
JS
Department of Urology, Henry Ford Hospital, Detroit, MI, USA.
Shah
Manan B
MB
Batiste
LaKeasha R
LR
Eaddy
Michael
M
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018666:Ureteroscopy; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D003911:Dextrans; C013471:dextranomer; D006820:Hyaluronic Acid