title: Randomized clinical trial comparing endoscopic treatment with dextranomer hyaluronic acid copolymer and Cohen's ureteral reimplantation for vesicoureteral reflux: long-term results.
abstract: OBJECTIVE
  To compare efficacy of Cohen's ureteral reimplantation and endoscopic treatment with Dx/HA in patients with primary VUR grades II, III and IV.
  
  
  METHODS
  From April 2002 to June 2004, patients over 1 year old with VUR grade I, II, III or IV were included. Patients were randomized into two groups: endoscopic treatment (ET) or ureteral reimplantation (UR). In the ET group, an ultrasonography study was performed 24 h and 1 month after surgery, and two voiding cystourethrographies at 3 and 6 months post treatment. In the UR group, an ultrasonography study was done 7 days and 1 month after surgery and a micturial cystography 6 months post surgery. A postoperative nuclear direct cystogram was performed 5 years later in both groups.
  
  
  RESULTS
  A total of 41 patients were included in this study: in ET 22 patients with 35 refluxing ureters and in UR 19 patients with 32 refluxing ureters. The VUR grades in ET were: 16 grade II, 16 grade III and 3 grade IV; and in UR: 15 grade II, 12 grade III and 5 grade IV. VUR was resolved in 91% (32/35) of ET (28% of ureters needed a second injection), and in 100% of UR group. Five years after the procedure, VUR was still resolved in 30/32 of ET and 32/32 of UR.
  
  
  CONCLUSIONS
  Short- and long-term follow up shows that multiple endoscopic treatment of VUR grades II, III and IV with Dx/HA is as effective as ureteral reimplantation.
authors.affiliation: Pediatric Urology, Pediatric Surgery Dept., Hospital Sant Joan de Déu, University of Barcelona, PasseigSant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain. lgarcia@hsjdbcn.org
authors.forename: L
authors.initials: L
authors.lastname: Garcia-Aparicio
authors.forename: J
authors.initials: J
authors.lastname: Rovira
authors.forename: E
authors.initials: E
authors.lastname: Blazquez-Gomez
authors.forename: L
authors.initials: L
authors.lastname: García-García
authors.forename: A
authors.initials: A
authors.lastname: Giménez-Llort
authors.forename: J
authors.initials: J
authors.lastname: Rodo
authors.forename: L
authors.initials: L
authors.lastname: Morales
mesh_terms: D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000627:therapeutic use*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D008297:Male; D012092:Replantation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid