title: The appearance of dextranomer-hyaluronic acid copolymer implants on ultrasound may predict resolution of vesicoureteral reflux after injection therapy.
abstract: OBJECTIVE
  To investigate the correlation between implant appearance on ultrasound (US) and voiding cystourethrography (VCUG) results after dextranomer-hyaluronic acid copolymer (DxHA) injection in children with vesicoureteral reflux (VUR).
  
  
  METHODS
  Consecutive cases of primary VUR treated by endoscopic subureteral injection of DxHA were retrospectively reviewed. All children had postoperative bladder US and VCUG with a mean interval of 34 days and 47 days after injection, respectively. VUR resolution at postoperative VCUG was considered as treatment success. Implant appearance on US was graded according to the retained volume and its location by visual inspection; it was then correlated with VCUG results using the Spearman correlation coefficient.
  
  
  RESULTS
  A total of 36 children (56 ureters) were identified in which 38 ureters (68%) had a clearly visualized implant on postoperative US and 40 ureters (71%) showed VUR resolution. The sensitivity of implant visualization on US for predicting reflux resolution was 73% (29/40), specificity 44% (7/16), positive predictive value 76% (29/38), and negative predictive value 39% (7/18). The grade 1, grade 2, and grade 3 implant appearances showed VUR resolution in 88% (22/25), 54% (7/13), and 61% (11/18), and showed persistent VUR in 8% (2/25), 15% (2/13), and 28% (5/18), respectively (p = 0.032).
  
  
  CONCLUSIONS
  The implant appearance on postoperative US showed good correlation with VCUG results in the early post-injection period. Large retained implants were associated with treatment success, while small or non-visualized implants were related to the persistent reflux.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Radiology, Chung-Ang University Hospital, School of Medicine, Seoul, Republic of Korea.
authors.forename: K J
authors.initials: KJ
authors.lastname: Park
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: hathor97.jeon@samsung.com.
authors.forename: T Y
authors.initials: TY
authors.lastname: Jeon
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Yoo
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: H
authors.initials: H
authors.lastname: Eo
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: K D
authors.initials: KD
authors.lastname: Song
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007223:Infant; D007267:Injections; D008297:Male; D011237:Predictive Value of Tests; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014554:Urination; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid