title: Concomitant endoureterotomy and dextranomer/hyaluronic acid subureteral injection for management of obstructive refluxing megaureter.
abstract: OBJECTIVE
  To present the results of our experience with combined endoureterotomy and endoscopic injection of dextranomer/hyaluronic acid (Deflux) for the treatment of primary obstructive refluxing megaureter (PORM).
  
  
  METHODS
  Eighteen children (12 female, 6 male; mean age-14 months) with 20 PORM units underwent concomitant endoureterotomy and endoscopic subureteral Deflux injection. All patients underwent endoureterotomy at the 6-o'clock position with insertion of a 3F Double-J ureteral stent into the obstructed segment of ureter and subureteral injection of Deflux at the 5-o'clock and 7-o'clock positions. The Double-J stent was left in place with its distal tip fixed with a single knot to the external genitalia for easy removal after 1 week. Patients with refluxing nonobstructive ureter on the contralateral side of the PORM unit (seven children) underwent simultaneous endoscopic subureteral injection of Deflux. Voiding cystourethrography (VCUG) was performed at 6 months, and ultrasonography was performed at 1 week 3, 6, and 12 months postoperatively.
  
  
  RESULTS
  With a mean follow-up of 30 months, the procedure was uneventful in all patients. Follow-up VCUG showed no evidence of reflux in 15 ureterorenal (75%), significant decrease in reflux grade in 2 (10%), and no change in 3 (15%) in the endoscopic treated PORM units. No evidence of reflux was observed in the treated contralateral refluxing nonobstructive ureters. Ultrasonography revealed no ureterovesical junction obstruction. In 19 ureterorenal (95%) units, there was a complete resolution or decrease in hydroureteronephrosis.
  
  
  CONCLUSIONS
  The results of this study demonstrate that combined endoureterotomy and subureteral injection of Deflux is safe and effective in the treatment of PORM in selected patients.
authors: Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir
authors: Abdol-Mohammad
authors: AM
authors: Kajbafzadeh
authors: Ali
authors: A
authors: Tourchi
mesh_terms: D003710:Demography; D003911:Dextrans / Q000008:administration & dosage / Q000627:therapeutic use*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D007267:Injections; D008297:Male; D011182:Postoperative Care; D011300:Preoperative Care; D014513:Ureter / Q000002:abnormalities* / Q000187:drug effects / Q000601:surgery*; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery* / Q000628:therapy; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000601:surgery* / Q000628:therapy
chemical_list: D003911:Dextrans; C094535:deflux; C013471:dextranomer; D006820:Hyaluronic Acid