title: Utility of dextranomer/hyaluronic acid injection in setting of bladder and ureteral anomalies.
abstract: OBJECTIVE
  Previous studies have shown that the cure rates after dextranomer/hyaluronic acid (Dx/HA) injection can be decreased in patients with neurogenic bladder, previous ureteroneocystostomy, duplicated ureters, or periureteral diverticula. We attempted to determine whether these factors reduce the efficacy of Dx/HA injection compared with that in otherwise normal patients.
  
  
  METHODS
  All children with vesicoureteral reflux (VUR) undergoing Dx/HA injection from April 2002 to March 2006 at two institutions were eligible for this study. Multivariate logistic regression models were built to assess the effect of bladder/ureteral anomalies on the success of Dx/HA injection. We adjusted for previously described predictors of injection success, including VUR grade, sex, age, surgeon experience, and injection technique.
  
  
  RESULTS
  A total of 543 refluxing ureters (373 patients) were included, of which 145 (27%) had persistent VUR on postoperative voiding cystourethrography; 86 ureters (16%) had anatomic anomalies. On univariate analysis, the most important predictors of injection failure were increasing VUR grade, male sex, younger age, subureteral injection, ureteral duplication anomaly, increasing Dx/HA volume, and surgeon experience. On multivariate analysis, however, the only significant predictors of injection failure were increasing VUR grade, subureteral injection technique, and surgeon experience. No anatomic or functional abnormalities, considered individually or grouped, significantly affected the probability of injection failure.
  
  
  CONCLUSIONS
  In our experience, children with functional and anatomic bladder/ureteral anomalies were no more likely to have Dx/HA injection fail than were children with uncomplicated VUR. The most important predictors of Dx/HA success remained VUR grade, injection technique, and surgeon experience. Dx/HA injection in patients with complex bladders could be a reasonable therapeutic option.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA. routh.jonathan@mayo.edu
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Kramer
authors.forename: Brant A
authors.initials: BA
authors.lastname: Inman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ashley
authors.forename: James J
authors.initials: JJ
authors.lastname: Wolpert
authors.forename: David R
authors.initials: DR
authors.lastname: Vandersteen
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Husmann
authors.forename: Yuri
authors.initials: Y
authors.lastname: Reinberg
mesh_terms: D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008297:Male; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities*; D001743:Urinary Bladder / Q000002:abnormalities*; D001745:Urinary Bladder Diseases / Q000150:complications*; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000628:therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid