Transurethral injection therapy with dextranomer/hyaluronic acid copolymer (Deflux) for treatment of secondary vesicoureteral reflux after renal transplantation.
OBJECTIVE
Secondary vesicoureteral reflux (SVUR) after renal transplantation may cause recurrent urinary-tract infections (UTI) and loss of renal function. There are only a few reports on the endoscopic treatment of SVUR by transurethral injection therapy. This is the first report of transurethral injection of dextranomer/hyaluronic acid copolymer (Deflux; Q-Med Scandinavia, Uppsala, Sweden) to relieve SVUR after renal transplantation.


METHODS
Between November 2003 and October 2005, four women were treated for SVUR with transurethral injections of dextranomer/hyaluronic acid copolymer. All patients had deterioration of renal function attributable to SVUR, recurrent UTI, or both. The mean follow-up was 29 months (range 16-38 months).


RESULTS
Initially, SVUR was corrected in all patients. Recurrent SVUR made a second treatment necessary in two patients. Three patients had no signs of SVUR 15, 27, and 36 months after the treatment. Renal function remained stable in these patients, and two were free of UTI. One of the patients who received two Deflux injections developed a filiform stenosis of the distal ureter, which was corrected by ureteropyeloplasty with the native ureter.


CONCLUSIONS
Transurethral injection therapy with Deflux is a minimally invasive treatment option for patients with SVUR after renal transplantation. A second treatment seems to be necessary in some cases. Complications such as ureteral obstruction may occur.
Department of Urology, University Hospital Basel, Basel, Switzerland. Hans-Helge.Seifert@usz.ch
H H
HH
Seifert
B
B
Mazzola
R
R
Ruszat
A
A
Muller
J
J
Steiger
A
A
Bachmann
T
T
Sulser
D000328:Adult; D003558:Cystoscopy; D003911:Dextrans / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D007267:Injections; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D012008:Recurrence; D014521:Urethra; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy*
D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid