title: Is there a learning curve for subureteric injection of dextranomer/hyaluronic acid in the treatment of vesicoureteral reflux?
abstract: OBJECTIVE
  To answer the question: 'Is there a learning curve associated with a subureteric injection of Deflux(®)?'
  
  
  METHODS
  We retrospectively reviewed charts of patients who received subureteric injection of dextranomer/hyaluronic acid (Deflux(®){AQ2}) (225 procedures) for treatment of vesicoureteral reflux (VUR) by four surgeons. The study included 55 patients, 82 ureters, who had postoperative follow-up with a voiding cystogram or nuclear medicine cystogram. Exclusion criteria were prior anti-refluxing procedures, duplicated collecting systems, and non-achievement of a negative intraoperative cystogram. Patients were divided into two groups based on whether or not they received an intraoperative cystogram after the injection. The two groups were compared for VUR resolution rates on follow-up imaging.
  
  
  RESULTS
  Twenty patients underwent an intraoperative cystogram (Group 1, 33 ureters) and 35 did not (Group 2, 49 ureters). The two groups were similar in age, preoperative reflux grade, amount of Deflux injected into each ureter, and time to postoperative studies. In Group 1, 11 ureters (33.3%) and also, in Group 2, 11 ureters (22.4%) had reflux on follow-up imaging.
  
  
  CONCLUSIONS
  There was no improvement in VUR resolution rate following subureteric injection of Deflux(®) when an intraoperative cystogram demonstrated no reflux to be present immediately after injection. Of ureters that did not reflux on intraoperative cystograms, one-third displayed return of reflux on follow-up imaging, which suggests no learning curve and that failures are not likely to be caused by poor surgical technique.
authors.affiliation: University of Utah Division of Urology, Primary Children's Medical Center, Department of Pediatric Urology, 100N Mario Capecchi Drive, Ste. 2200, Salt Lake City, UT 84113-1100, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Bennett
authors.forename: Laura M
authors.initials: LM
authors.lastname: Foot
authors.forename: E Jason
authors.initials: EJ
authors.lastname: Abel
authors.forename: Brent W
authors.initials: BW
authors.lastname: Snow
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Cartwright
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Devries
authors.forename: M Chad
authors.initials: MC
authors.lastname: Wallis
mesh_terms: D002648:Child; D003911:Dextrans / Q000008:administration & dosage*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D007432:Intraoperative Period; D059032:Learning Curve; D019736:Prostheses and Implants; D011859:Radiography; D014513:Ureter; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014572:Urology / Q000193:education*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid