title: Prospective study using a new bulking agent for the treatment of vesicoureteral reflux: polyacrylamide hydrogel.
abstract: OBJECTIVE
  Vesicoureteral reflux is frequently diagnosed in the pediatric population. Endoscopic treatment has become a popular form of first-line therapy. Available products offer good short-term success rates. However, the cost of these injected implants is an issue. We evaluated the success of endoscopic treatment for vesicoureteral reflux using polyacrylamide hydrogel.
  
  
  METHODS
  We performed a single center, single surgeon, prospective, off-label study using polyacrylamide hydrogel to treat vesicoureteral reflux. All patients underwent endoscopic subureteral double hydrodistention implantation technique injection followed by renal ultrasound and voiding cystourethrogram at 3 months postoperatively to confirm the absence of de novo hydronephrosis and correction of vesicoureteral reflux (grade 0).
  
  
  RESULTS
  A total of 40 patients (69 refluxing ureters) underwent polyacrylamide hydrogel injection. Median age at surgery was 50 months. Bilateral reflux was identified in 29 patients (73%). Nine patients had duplex systems, 2 with reflux into both moieties. Reflux was graded using the International Reflux Study in Children grading system, with grade I seen in 9 ureters, II in 17, III in 20, IV in 18 and V in 5. Mean volume injected was 1.1 ml. Success rate for grade I to III vesicoureteral reflux at 3 months after a single treatment was 87%, and the overall success for all grades was 81.2%.
  
  
  CONCLUSIONS
  Off-label use of polyacrylamide hydrogel injection therapy for primarily low grade vesicoureteral reflux demonstrates that the technique and short-term success rates are comparable to the most popular bulking agent, dextranomer/hyaluronic acid. These results suggest that further trials comparing polyacrylamide hydrogel and dextranomer/hyaluronic acid would be worthwhile.
authors.affiliation: Division of Urology, Quebec University Hospital Center, Laval University, Quebec City, Quebec, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cloutier
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Blais
authors.forename: Katherine
authors.initials: K
authors.lastname: Moore
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bolduc
mesh_terms: D000180:Acrylic Resins / Q000627:therapeutic use*; D000283:Administration, Intravesical; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003558:Cystoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020100:Hydrogels / Q000627:therapeutic use; D007223:Infant; D008297:Male; D056687:Off-Label Use; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014563:Urodynamics / Q000502:physiology; D014567:Urography / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000180:Acrylic Resins; C528271:Bulkamid; D020100:Hydrogels; C016680:polyacrylamide gels
keywords: DMSA; Dx/HA; PAHG; PPC; RRU; RUS; VCUG; VUR; acrylamides; dextranomer/hyaluronic acid; dimercapto-succinic acid; endoscopy; hydrogel; polyacrylamide hydrogel; polyacrylate/polyalcohol copolymer; refluxing renal unit; renal ultrasound; vesico-ureteral reflux; vesicoureteral reflux; voiding cystourethrogram