title: Clinical value of persistent but downgraded vesicoureteral reflux after dextranomer/hyaluronic acid injection in children.
abstract: We aimed to investigate the clinical value of persistent but downgraded vesicoureteral reflux (VUR) after dextranomer/hyaluronic acid (Dx/HA) injection in children. The medical records of 128 children (195 ureters) who underwent Dx/HA injections for VUR were reviewed. The incidences of pre- and post-operative febrile urinary tract infections (UTIs) were analyzed in children with or without persistent VUR on voiding cystourethrography (VCUG) 3 months postoperatively. The surgical results of VUR persistent children who underwent a single additional injection were assessed. The VUR resolved completely in 100 ureters (51.3%), was persistent in 95 ureters, and newly developed in 2 ureters. The incidence of pre/post-operative febrile UTIs were 0.35 ± 0.39 per year and 0.07 ± 0.32 per year in VUR resolved children (P < 0.001), and 0.76 ± 1.18 per year and 0.20 ± 0.61 per year in VUR persistent children (P < 0.001). A single additional Dx/HA injection (44 ureters) resolved VUR in 29 ureters (65.9%), and also reduced the VUR to grade I in 7 ureters (15.9%), II in 4 (9.1%), and III in 4 (9.1%). Even in children with persistent VUR after Dx/HA injection, the incidence of febrile UTIs decreased markedly. The VUR grade significantly decreases after single additional Dx/HA injection.
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Minki
authors.initials: M
authors.lastname: Baek
authors.forename: Min Young
authors.initials: MY
authors.lastname: Kang
authors.forename: Hahn-Ey
authors.initials: HE
authors.lastname: Lee
authors.forename: Kwanjin
authors.initials: K
authors.lastname: Park
authors.forename: Hwang
authors.initials: H
authors.lastname: Choi
mesh_terms: D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000150:complications / Q000453:epidemiology; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy* / Q000601:surgery
chemical_list: D003911:Dextrans; C013471:dextranomer; D006820:Hyaluronic Acid
keywords: Endoscopy; Pediatrics; Pyelonephritis; Vesico-Ureteral Reflux