title: Intermediate to long-term follow-up indicates low risk of recurrence after Double HIT endoscopic treatment for primary vesico-ureteral reflux.
abstract: OBJECTIVE
  Follow-up of patients undergoing dextranomer/hyaluronic acid injection for vesico-ureteral reflux (VUR) is controversial. The purpose of our study was to test the hypothesis that patients undergoing the double hydrodistention-implantation technique (Double HIT) have a higher clinical and radiographic success rate.
  
  
  METHODS
  Patients undergoing Double HIT endoscopic injection for VUR were prospectively identified. Patients underwent an ultrasound at 6 weeks to assess the implants, and, if visible, prophylactic antibiotics were discontinued and patients were scheduled for a 1-year voiding cystourethrogram (VCUG). Radiographic success was defined as a negative VCUG and clinical success as no febrile urinary tract infections at 1 year.
  
  
  RESULTS
  A total of 54 patients underwent endoscopic injection for VUR. Twenty-five (51%) were compliant with the 1 year follow-up; 18 non-compliant patients were contacted and their clinical status assessed. Thirty patients eventually completed the 1-year VCUG at a mean of 12.2 months (range 10-20). Among the 60% of patients with 1-year radiographic follow-up, 2 had persistent VUR for a radiologic success rate of 93%. All radiographic failures were infection-free. Of the 80% (43/54) of patients with available clinical data, 3 (7%) had afebrile UTI for a clinical success rate of 93%.
  
  
  CONCLUSIONS
  The Double HIT leads to a 93% clinical and 93% radiographic intermediate/long-term success rate. With this technique, better outcomes were achieved with fewer recurrences than previously reported. These favorable results challenge the need for postoperative VCUG in asymptomatic patients after the Double HIT.
authors.affiliation: Children's Healthcare of Atlanta and Emory University School of Medicine, 5445 Meridian Mark Rd, Atlanta, GA 30342, USA.
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Kalisvaart
authors.forename: Hal C
authors.initials: HC
authors.lastname: Scherz
authors.forename: Scott
authors.initials: S
authors.lastname: Cuda
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Kaye
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003911:Dextrans / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000494:pharmacology*; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D011446:Prospective Studies; D019736:Prostheses and Implants; D018570:Risk Assessment; D055502:Secondary Prevention; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D018666:Ureteroscopy / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D003911:Dextrans; C013471:dextranomer; D006820:Hyaluronic Acid