title: Salvage ureteral reimplantation after failure of dextranomer/hyaluronic acid injection.
abstract: OBJECTIVE
  Ureteroneocystostomy after dextranomer/hyaluronic acid injection is reportedly associated with significantly more morbidity, and increased operative time, length of stay and postoperative obstruction. To evaluate our experience, we reviewed results of patients who underwent salvage ureteral reimplantation following failed dextranomer/hyaluronic acid injection.
  
  
  METHODS
  We retrospectively reviewed charts of patients at a single institution who underwent intravesical ureteral reimplantation as salvage treatment following failed dextranomer/hyaluronic acid injection. Data points such as operative time, blood loss and length of stay were compared to those of controls undergoing de novo reimplantation by the same surgeons. Statistical analysis was performed using Student's t test and chi-square test.
  
  
  RESULTS
  We identified 18 patients who underwent salvage reimplant. We compared data to an equal number of controls. Mean age (4.28 years in patients vs 3.34 years in controls, p = 0.62) and mean reflux grade at reimplant (3.15 vs 3.40, p = 0.97) were comparable between the groups. Operative time (128 vs 141.9 minutes, p = 0.14), blood loss (12.9 vs 11.9 ml, p = 0.71) and length of hospital stay (1.68 vs 1.3 days, p = 0.25) were not significantly different. No statistically significant differences were found regarding any of the compared variables.
  
  
  CONCLUSIONS
  Ureteral reimplantation after dextranomer/hyaluronic acid injection is no more difficult than primary ureteral reimplantation regarding operative time, blood loss and length of hospital stay. These results support dextranomer/hyaluronic acid as initial operative treatment of vesicoureteral reflux when deemed appropriate and may further shift the paradigm of treatment away from prolonged medical management.
authors.affiliation: University of California, San Diego and Naval Medical Center (MC), San Diego, California, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Sparks
authors.forename: Marvalyn
authors.initials: M
authors.lastname: Decambre
authors.forename: Matthew
authors.initials: M
authors.lastname: Christman
authors.forename: George
authors.initials: G
authors.lastname: Kaplan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Holmes
mesh_terms: D000283:Administration, Intravesical; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016879:Salvage Therapy; D017211:Treatment Failure; D014513:Ureter / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000601:surgery* / Q000628:therapy
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid