title: Presence of dextranomer-hyaluronic acid (DxHA) mound on postoperative ultrasound does not predict resolution of vesicoureteral reflux.
abstract: OBJECTIVE
  Dextranomer-hyaluronic acid (DxHA) injection is an accepted treatment for vesicoureteral reflux (VUR), with success rates as high as 85-90% in selected patients. The DxHA mound can often be seen on postoperative ultrasound. We sought to determine whether the presence or absence of this mound on ultrasound can predict resolution of VUR on voiding cystourethrogram (VCUG).
  
  
  METHODS
  A retrospective study evaluating patients who underwent cystoscopy and injection of DxHA from 2003 to the present was performed. Demographic variables, laterality and grade of VUR, postoperative ultrasound findings, and presence of VUR on postoperative VCUG were recorded.
  
  
  RESULTS
  Fifty-one patients (95 ureters) underwent DxHA injection and had a postoperative ultrasound and VCUG for review. Five patients with persistent voiding dysfunction were excluded, leaving 46 patients and 86 ureters for review. The mean age at time of injection was 5.2 years (range 0.75-11 years) and mean grade of VUR was 2.5 (range 1-5). After DxHA injection, 75% of the ureters showed resolution of VUR, while 25% demonstrated persistent VUR. No correlation was made between the presence of DxHA mound and resolution of VUR on VCUG.
  
  
  CONCLUSIONS
  In this series, the presence of a DxHA mound on initial postoperative ultrasound does not predict resolution of VUR. A larger prospective study is needed to evaluate additional parameters.
authors.affiliation: Division of Urology, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island 02905, USA. pamelaellsworth@aol.com
authors.forename: Pamela I
authors.initials: PI
authors.lastname: Ellsworth
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Yates
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Caldamone
mesh_terms: D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D003911:Dextrans / Q000627:therapeutic use*; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007223:Infant; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000000981:diagnostic imaging; D014554:Urination / Q000502:physiology; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid