Long-term followup after endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid copolymer in patients with neurogenic bladder.
OBJECTIVE
Subureteral injection of dextranomer/hyaluronic acid copolymer is a minimally invasive method to treat vesicoureteral reflux. We report short and long-term success in treating secondary vesicoureteral reflux in patients with neurogenic bladder dysfunction or severe voiding dysfunction.


METHODS
We performed a retrospective chart review of all subureteral injection procedures done to identify patients with neurogenic bladder or severe voiding dysfunction. Short (less than 12 months) and long-term vesicoureteral reflux results for patients and ureters were recorded. Preoperative urodynamics and radiographic findings were reviewed. Preoperative factors were evaluated to identify patients with greater chances of success.


RESULTS
A total of 12 patients (17 ureters) were identified (10 with neurogenic bladder and 2 with Hinman syndrome). Short-term success (no vesicoureteral reflux) was achieved in 50% of patients and 58% of ureters. At a median followup of 4.5 years (range 1 to 9) success decreased to 35% of ureters. Overall, long-term success was found in 25% of patients who were free of vesicoureteral reflux and required no additional surgery. Of the patients 41% required additional urological surgery for vesicoureteral reflux or related conditions.


CONCLUSIONS
With long-term followup many patients who had initial improvement in vesicoureteral reflux ultimately experienced treatment failure and recurrence of reflux. At a median of 4.5 years 25% of patients with neurogenic bladder and vesicoureteral reflux were successfully treated with endoscopic injection of dextranomer/hyaluronic acid copolymer.
Division of Urology, Oregon Health & Science University, Portland, Oregon 97239, USA.
A S
AS
Polackwich
S J
SJ
Skoog
J C
JC
Austin
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000150:complications*; D014718:Vesico-Ureteral Reflux / Q000209:etiology* / Q000628:therapy*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid