Outcome analysis of mini-ureteroneocystostomy versus dextranomer/hyaluronic acid copolymer injection for unilateral vesicoureteral reflux.
OBJECTIVE
Injecting dextranomer/hyaluronic acid copolymer has gained popularity as first line treatment for vesicoureteral reflux. However, ureteroneocystostomy has typically been more successful than endoscopic treatments. We evaluated the outcome of dextranomer/hyaluronic acid copolymer injection vs that of extravesical ureteroneocystostomy via a 2 cm inguinal incision (mini-ureteroneocystostomy) for unilateral vesicoureteral reflux.


METHODS
The records were analyzed of all patients from 2003 to 2007 with unilateral vesicoureteral reflux who underwent mini-ureteroneocystostomy or dextranomer/hyaluronic acid copolymer injection. Mini-ureteroneocystostomy was performed via a 2 cm inguinal incision. Of the injections 66% were delivered via an intraureteral tunnel technique. Statistical analysis was done to compare differences in clinical features and success rates. All p values were 2-sided with significance at p <0.05.


RESULTS
From 2003 to 2007, 99 children underwent operative repair of unilateral vesicoureteral reflux, including 42 via dextranomer/hyaluronic acid copolymer injection and 57 via mini-ureteroneocystostomy. There were no significant differences between the groups in terms of preoperative clinical or anatomical variables except for higher preoperative reflux grade in the mini-ureteroneocystostomy cohort (p <0.001). Patients undergoing mini-ureteroneocystostomy were more likely to be cured (100% vs 78%, p = 0.001). De novo contralateral vesicoureteral reflux occurred in the 2 cohorts to a similar degree (p = 0.15). The injection cohort was more likely to be discharged home on an outpatient basis (100% vs 82%, p = 0.002). No complications occurred in the dextranomer/hyaluronic acid copolymer cohort, while 2 children required intervention for complications after mini-ureteroneocystostomy.


CONCLUSIONS
This study details that the 2 procedures may be successfully performed in the outpatient setting, and yet even for more advanced vesicoureteral reflux mini-ureteroneocystostomy achieves greater overall success. This procedure has become our standard of care for unilateral vesicoureteral reflux.
Ashley
Richard
R
Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
Vandersteen
David
D
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000379:methods*; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D007267:Injections; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D019736:Prostheses and Implants; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery / Q000628:therapy*
D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid