title: Recent trends in the surgical management of primary vesicoureteral reflux in the era of dextranomer/hyaluronic acid.
abstract: OBJECTIVE
  Since its inception as a technology in the United States, endoscopic correction of vesicoureteral reflux has become a popular treatment option in children with vesicoureteral reflux with reported wide use. We determined whether the increasing trend in use in the United States after the introduction of dextranomer/hyaluronic acid has been sustained.
  
  
  METHODS
  We abstracted data on pediatric patients treated with ureteral reimplantation or dextranomer/hyaluronic acid intervention for vesicoureteral reflux from 2004 to 2011 from the PHIS (Pediatric Health Information System) database. Patients with coding data indicating diagnoses other than primary vesicoureteral reflux and hospitals reporting less than 80% of ambulatory surgery cases by CPT code were excluded from study.
  
  
  RESULTS
  We identified 14,430 patients (17,826 procedures), of whom 49% underwent reimplantation and 51% underwent dextranomer/hyaluronic acid injection. Of the patients 83% were female with a median age at surgery of 4.7 years (IQR 2.5-7.2). Linear regression showed a significant downward trend in the average total number of antireflux operations per institution during the study period. This was attributable to a decrease in the average rate of dextranomer/hyaluronic acid interventions because the average reimplantation rate remained stable during this time.
  
  
  CONCLUSIONS
  At freestanding pediatric hospitals enrolled in the PHIS database there is a trend toward decreasing intervention for primary vesicoureteral reflux, which appears to be due to decreased use of injection therapy. This may reflect a philosophical change in reflux management by injection therapy.
authors.affiliation: Departments of Urology and Research, Connecticut Children's Medical Center, Hartford, Connecticut. Electronic address: kherbst@ccmckids.org.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Herbst
authors.affiliation: Department of Urology, University of Virginia Children's Hospital, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Sean T
authors.initials: ST
authors.lastname: Corbett
authors.affiliation: Department of Urology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
authors.affiliation: Division of Urology, Hasbro Children's Hospital, Brown University School of Medicine, Providence, Rhode Island.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Caldamone
mesh_terms: D002675:Child, Preschool; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012092:Replantation; D014513:Ureter / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data*; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid
keywords: dextranomer-hyaluronic acid copolymer; kidney; replantation; ureter; vesico-ureteral reflux