title: Can we rely on the presence of dextranomer-hyaluronic acid copolymer mounds on ultrasound to predict vesicoureteral reflux resolution after injection therapy?
abstract: OBJECTIVE
  We determined whether the presence or absence of dextranomer-hyaluronic acid copolymer mounds on bladder ultrasound coincides with voiding cystourethrogram results after injection therapy in children with primary vesicoureteral reflux.
  
  
  METHODS
  We retrospectively reviewed consecutive cases of dextranomer-hyaluronic acid copolymer injection for primary vesicoureteral reflux. The primary outcome investigated was the appearance of dextranomer-hyaluronic acid copolymer mounds on ultrasound and their association with voiding cystourethrogram results postoperatively. An intramural dextranomer-hyaluronic acid copolymer mound on ultrasound was considered a negative test result for vesicoureteral reflux.
  
  
  RESULTS
  A total of 187 cases were identified, of which 132 had imaging available for evaluation. Intramural mounds were seen on ultrasound in 86 cases postoperatively, of which 34 (40%) had a positive voiding cystourethrogram. Of 46 cases in which no mound was identified 21 (46%) had a positive voiding cystourethrogram. The sensitivity of ultrasound to determine the presence or absence of vesicoureteral reflux was 38%, specificity was 67%, accuracy was 55%, the positive predictive value was 46% and the negative predictive value was 60%.
  
  
  CONCLUSIONS
  Our results indicate poor correlation of dextranomer-hyaluronic acid copolymer mound appearance on ultrasound with voiding cystourethrogram results after injection. To adequately evaluate for the resolution of vesicoureteral reflux a voiding cystogram or nuclear medicine cystogram needs to be performed after injection therapy.
authors.affiliation: Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA. iszamilpa@salud.unm.edu
authors.forename: Ismael
authors.initials: I
authors.lastname: Zamilpa
authors.forename: Martin A
authors.initials: MA
authors.lastname: Koyle
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grady
authors.forename: Byron D
authors.initials: BD
authors.lastname: Joyner
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage* / Q000032:analysis; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000032:analysis; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000628:therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid