title: Dextranomer/hyaluronic acid endoscopic injection is effective in the treatment of intermediate and high grade vesicoureteral reflux in patients with complete duplex systems.
abstract: OBJECTIVE
  Endoscopic subureteral injection of dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis or surgical treatment for vesicoureteral reflux. We evaluated the effectiveness of endoscopic injection of dextranomer/hyaluronic acid in intermediate and high grade vesicoureteral reflux in patients with complete duplex collecting systems.
  
  
  METHODS
  A total of 123 children underwent endoscopic correction of intermediate or high grade vesicoureteral reflux using injection of dextranomer/hyaluronic acid into complete duplex systems between 2001 and 2010. Vesicoureteral reflux was diagnosed by voiding cystourethrogram, and dimercapto-succinic acid scan was performed to evaluate the presence of renal scarring. Followup ultrasound and voiding cystourethrogram were performed 3 months after the outpatient procedure and renal ultrasound thereafter every 2 years. Mean followup was 6.7 years.
  
  
  RESULTS
  Complete duplex systems were unilateral in 110 patients and bilateral in 13. Reflux severity in the 136 refluxing units was grade II in 1 (0.7%), III in 52 (38.2%), IV in 61 (44.9%) and V in 22 (16.2%). Dimercapto-succinic acid scan revealed renal functional abnormalities in 63 children (51.2%). Vesicoureteral reflux resolved after the first endoscopic injection of dextranomer/hyaluronic acid in 93 ureters (68.4%), after a second injection in 35 (25.7%) and after a third injection in 8 (5.9%). Febrile urinary tract infection developed in 5 patients (4.1%) during followup. No patient required ureteral reimplantation or experienced significant complications.
  
  
  CONCLUSIONS
  Our results confirm the safety and efficacy of endoscopic injection of dextranomer/hyaluronic acid in eradicating intermediate and high grade vesicoureteral reflux in patients with complete duplex systems. We recommend this minimally invasive, 15-minute outpatient procedure as a viable option for treating intermediate and high grade vesicoureteral reflux in patients with complete duplex collecting systems.
authors.affiliation: National Children's Research Center, Our Lady's Children's Hospital and National Children's Hospital, Dublin, Ireland.
authors.forename: Manuela
authors.initials: M
authors.lastname: Hunziker
authors.forename: Nochiparambil
authors.initials: N
authors.lastname: Mohanan
authors.forename: Prem
authors.initials: P
authors.lastname: Puri
mesh_terms: D000015:Abnormalities, Multiple; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D007267:Injections / Q000379:methods; D007668:Kidney / Q000002:abnormalities*; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014513:Ureter / Q000002:abnormalities*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000628:therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid