title: Prospective study of polydimethylsiloxane vs dextranomer/hyaluronic acid injection for treatment of vesicoureteral reflux.
abstract: OBJECTIVE
  Endoscopic injection of a bulking agent is becoming a first-line treatment for low grade vesicoureteral reflux. We prospectively compared the efficacy of 2 such products commercially available in Canada.
  
  
  METHODS
  A total of 275 patients with documented grade I to V vesicoureteral reflux were prospectively enrolled in a comparative study between April 2005 and February 2011 to be randomly treated endoscopically with either polydimethylsiloxane (Macroplastique®) or dextranomer/hyaluronic acid copolymer (Deflux®). Of the ureters 202 were treated with polydimethylsiloxane and 197 with dextranomer/hyaluronic acid copolymer. Patients were followed with voiding cystourethrography at 3 months and renal ultrasonography at 3 months and at 1 year. Median followup was 4.3 years. The primary outcome was surgical success (resolution vs nonresolution), and secondary outcomes included occurrence of adverse events.
  
  
  RESULTS
  Vesicoureteral reflux was fully corrected in 182 of 202 ureters (90%) treated with polydimethylsiloxane, compared to 159 of 197 (81%) treated with dextranomer/hyaluronic acid copolymer (p <0.05). Obstruction was found in 5 ureters. Univariate and multivariate analyses did not allow identification of any characteristics that could explain the significant difference in the success rates except for the type of product used.
  
  
  CONCLUSIONS
  We present the largest known prospective evaluation comparing 2 bulking agents for the treatment of vesicoureteral reflux. Endoscopic injection of polydimethylsiloxane resulted in a better success rate than dextranomer/hyaluronic acid copolymer. The rate of resolution obtained with the latter is lower than those previously published due to the inclusion of high grade reflux.
authors.affiliation: Division of Urology, Department of Surgery, CHU de Québec, Université Laval, Quebec City, Quebec, Canada. Electronic address: katherine.moore.1@ulaval.ca.
authors.forename: Katherine
authors.initials: K
authors.lastname: Moore
authors.affiliation: Division of Urology, Department of Surgery, CHU de Québec, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bolduc
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage*; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D007267:Injections; D008297:Male; D011446:Prospective Studies; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D003911:Dextrans; D004129:Dimethylpolysiloxanes; C487487:dextranomer-hyaluronic acid copolymer; C013830:baysilon; D006820:Hyaluronic Acid
keywords: endoscopy; hyaluronic acid; injections; urinary tract infections; vesico-ureteral reflux