title: Endoscopic hyaluronic acid/dextranomer gel implantation is effective as first-line treatment of vesicoureteral reflux (VUR) in children: a single centre experience.
abstract: OBJECTIVE
  Aim of the study was to analyse the success rate of endoscopic treatment (ET) using Dx/HA for primary vesicoureteral reflux (VUR) in children and to assess the incidence of postoperative urinary tract infections (UTIs).
  
  
  METHODS
  We retrospectively reviewed the charts of 103 children with VUR grade II-V who underwent ET, including children with additional urogenital malformations. Outcomes were verified with voiding cystourethrography (VCUG) and periodical urinalysis.
  
  
  RESULTS
  103 children with a total of 174 ureters underwent ET. 71 patients presented with bilateral VUR. Additional malformations were: duplex ureters (19 patients), posterior urethral valves (PUV) (12 patients), diverticulum (4 patients), neurogenic bladder and ectopic orifice. VUR grade was II in 52, III in 74, IV in 41 and V in 7 ureters, respectively. Postoperative VCUG demonstrated no VUR in 140 ureters (80%) and diminished VUR grade in an additional 18 ureters (total 91%). After a second ET, VCUG was negative in 28 ureters. The overall success rate was 98%. 30 patients had had more than 3 febrile and 67 patients had had 1-3 febrile UTIs before ET. 4 out of 103 patients (3.9%) had 1 febrile UTI within the first year of follow-up. Serious complications after ET were not noted.
  
  
  CONCLUSIONS
  ET is effective at eliminating VUR in children, even in patients with high-grade reflux, as well as in patients with VUR and additional malformations. Early intervention may reduce the incidence of UTIs and prevent long-term renal damage.
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland.
authors.forename: F-M
authors.initials: FM
authors.lastname: Häcker
authors.forename: M
authors.initials: M
authors.lastname: Frech-Dörfler
authors.forename: M
authors.initials: M
authors.lastname: von Rotz
authors.forename: C
authors.initials: C
authors.lastname: Rudin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans; D004724:Endoscopy; D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid; D015994:Incidence; D007223:Infant; D008297:Male; D019736:Prostheses and Implants; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000601:surgery*
chemical_list: D003911:Dextrans; D005782:Gels; C094535:deflux; D006820:Hyaluronic Acid