title: Acute and delayed vesicoureteral obstruction after endoscopic treatment of primary vesicoureteral reflux with dextranomer/hyaluronic acid copolymer: why and how to manage.
abstract: OBJECTIVE
  To present our cases of ureteral obstruction after endoscopic treatment of vesicoureteral reflux (VUR) with dextranomer/hyaluronic acid (Dx/HA).
  
  
  METHODS
  We collected data from patients who had suffered ureteral obstruction after endoscopic treatment of VUR with Dx/HA in our institution.
  
  
  RESULTS
  From April 2002 to April 2011 we treated endoscopically 475 ureters with VUR, and detected 5 ureteral obstructions. Median age at reflux treatment was 39 months. Reflux grade before treatment was III in one patient and IV in four. Three ureterovesical junctions (UVJ) were blocked after a second endoscopic treatment. The median of Dx/HA injected was 1 ml (0.6-1.1). In two patients ureteral obstruction presented acutely and was treated with a ureteral stent. In the other three, the ureteral obstruction appeared gradually and was detected by ultrasound scans and MAG3 diuretic renogram; one underwent nephrectomy because of poor renal function, and the other two were treated with endoscopic dilatation of the UVJ. In all these patients both reflux and obstructions have resolved.
  
  
  CONCLUSIONS
  On preoperative cystography, three of the patients had a narrowed distal ureter, and probably had a refluxing and obstructive megaureter. Other causes are not clear, except for those patients with acute presentation in whom edema of the UVJ was found. Ureteral obstruction after endoscopic treatment of VUR is rare. Endoscopic intervention such as ureteral stent placement or high-pressure balloon dilatation of the UVJ has good results as a treatment of acute and delayed obstruction.
authors.affiliation: Pediatric Urology Unit, Pediatric Surgery Dept, Hospital Sant Joan de Déu, University of Barcelona, Spain. lgarcia@hsjdbcn.org
authors.forename: L
authors.initials: L
authors.lastname: García-Aparicio
authors.forename: J
authors.initials: J
authors.lastname: Rodo
authors.forename: P
authors.initials: P
authors.lastname: Palazon
authors.forename: O
authors.initials: O
authors.lastname: Martín
authors.forename: E
authors.initials: E
authors.lastname: Blázquez-Gómez
authors.forename: A
authors.initials: A
authors.lastname: Manzanares
authors.forename: N
authors.initials: N
authors.lastname: García-Smith
authors.forename: M
authors.initials: M
authors.lastname: Bejarano
authors.forename: I
authors.initials: I
authors.lastname: de Haro
authors.forename: J M
authors.initials: JM
authors.lastname: Ribó
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D003911:Dextrans / Q000627:therapeutic use*; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D006869:Hydronephrosis / Q000209:etiology / Q000601:surgery; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000209:etiology* / Q000628:therapy*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid