title: Intraureteral injection of NASHA/Dx gel under direct ureteroscopic visualization for the treatment of primary high-grade vesicoureteral reflux.
abstract: OBJECTIVE
  To present a preliminary experience with the modified technique of extravesical intraureteral injection of non-animal-stabilized hyaluronic acid/dextranomer (NASHA/Dx) gel under direct ureteroscopic visualization for the treatment of primary high-grade vesicoureteral reflux (VUR).
  
  
  METHODS
  The medical records of all pediatric patients (age range, 0-14 years) who underwent intraureteral injection of NASHA/Dx gel under direct ureteroscopic visualization for the treatment of primary high-grade VUR during the period June 2006-June 2010 were reviewed.
  
  
  RESULTS
  Eighty-nine children (61 boys, 28 girls; M:F ratio, 2.1) underwent intraureteral injection of NASHA/Dx gel under direct ureteroscopic visualization for the treatment of primary high-grade VUR during the study period. VUR completely disappeared after the injection of NASHA/Dx gel into 105 (73%) of 144 ureters, with no further treatment required. Thirty-five (24.3%) required a second injection, and 2 (1.4%) required a third injection for resolution of their VUR. No intraoperative complications were observed. No ureteral obstruction during follow-up was observed using ultrasound or micturition studies.
  
  
  CONCLUSIONS
  Intraureteral injection of NASHA/Dx gel under direct ureteroscopic visualization is safe and effective in the treatment of primary high-grade VUR, including cases with ureteral duplication, if the ureteral meatus is easy to pass through without mechanical dilation. This approach represents an effective and safe alternative to antibiotic prophylaxis alone and open surgery.
authors.affiliation: Paediatric Surgery, Giannina Gaslini Children’s Hospital and Research Institute, Largo G. Gaslini 5, University of Genoa, Italy. girolamomattioli@ospedale-gaslini.ge.it
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
authors.forename: Edoardo
authors.initials: E
authors.lastname: Guida
authors.forename: Valentina
authors.initials: V
authors.lastname: Rossi
authors.forename: Emilio
authors.initials: E
authors.lastname: Podestà
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Jasonni
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Ghiggeri
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D019233:Retreatment; D012189:Retrospective Studies; D014513:Ureter; D018666:Ureteroscopy; D014546:Urinary Catheterization; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy*
chemical_list: D000276:Adjuvants, Immunologic; D003911:Dextrans; D005782:Gels; C496587:NASHA-Dx copolymer; D006820:Hyaluronic Acid