title: Unilateral vesicoureteral reflux: does endoscopic injection based on the cystoscopic appearance of the ureteral orifice decrease the incidence of de-novo contralateral reflux?
abstract: OBJECTIVE
  In patients with unilateral vesicoureteral reflux (VUR), it has been suggested that injection of a non-refluxing but cystoscopically abnormal contralateral ureteral orifice (UO) with dextranomer/hyaluronic acid (Dx/HA) should be performed to prevent the development of de-novo contralateral VUR. We evaluate the effectiveness of this practice.
  
  
  METHODS
  Patients with primary unilateral VUR undergoing injection of Dx/HA from 2002 to 2005 at two institutions were eligible. Patients with unilateral VUR with cystoscopically abnormal contralateral UOs were injected with Dx/HA, while patients with normal appearing UOs received no treatment. Multivariate logistic regression models were used to estimate the impact of prophylactic injection on the development of de-novo contralateral VUR.
  
  
  RESULTS
  In total, 101 patients with unilateral VUR and an abnormal appearing contralateral UO underwent prophylactic injection of Dx/HA while 45 patients with a normal appearing contralateral UO were untreated. In patients receiving prophylactic Dx/HA, 9% (9/101) of the previously non-refluxing ureters developed de-novo VUR. Similarly, 13% (6/45) of patients with a normal appearing UO treated by observation alone developed de-novo VUR (P=0.55). The overall incidence of 10% (15/146) de-novo contralateral VUR matches published results where this protocol was not followed.
  
  
  CONCLUSIONS
  Our findings suggest that cystoscopic assessment and prophylactic treatment of an abnormal appearing, non-refluxing contralateral UO with Dx/HA is of little clinical benefit and should be abandoned.
authors.affiliation: Department of Urology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55901, USA. routh.jonathan@mayo.edu
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Routh
authors.forename: Brant A
authors.initials: BA
authors.lastname: Inman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ashley
authors.forename: David R
authors.initials: DR
authors.lastname: Vandersteen
authors.forename: Yuri
authors.initials: Y
authors.lastname: Reinberg
authors.forename: James J
authors.initials: JJ
authors.lastname: Wolpert
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Kramer
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Husmann
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003558:Cystoscopy; D003911:Dextrans / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D019564:Unnecessary Procedures; D014513:Ureter / Q000473:pathology*; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid