Comparison of results of endoscopic correction of vesicoureteral reflux in children using two bulking substances: Dextranomer/hyaluronic acid copolymer (Deflux) versus polyacrylate-polyalcohol copolymer (Vantris).
BACKGROUND
Endoscopic correction of vesicoureteral reflux (VUR) in children offers minimally invasive management and is widely used as a first-line procedure for all grades of reflux. However, there is debate about which tissue-augmenting substance is the best to use. The aim of this study was to evaluate the efficacy of two bulking substances, Deflux (Dx/HA) and Vantris (PPC), for endoscopic treatment of VUR in children.


METHODS
From 2009 to 2012, 65 children (50 girls and 15 boys) aged 1.45-9.9 years (mean 4.85 ± 2.52) underwent endoscopic correction of VUR using Deflux. VUR was unilateral in 31 patients and bilateral in 34 patients, comprising 108 renal refluxing units (RRUs) grades: II in 52, III in 47, IV in 7, and V in 2. From 2012, 68 children (43 girls and 25 boys) aged 0.6-17.9 years (mean 4.89 ± 3.46) were treated with Vantris. VUR was unilateral in 33 and bilateral in 35 patients, comprising 109 RRUs grades: II in 48, III in 29, IV in 13, and V in 19. Voiding cystourethrogram was done 3 months after procedure.


RESULTS
All patients completed follow-up (summary Table). With Deflux, reflux resolved in almost 93% of RRUs after two procedures (in 63% after first injection), with Vantris, VUR was corrected in the same percentage after one procedure.


CONCLUSIONS
The success rate with Deflux ranges between 68% and 92% (only 50-70% after single injection). The reported possibility of reflux recurrence after successful Deflux treatment, and the need for repeated injection led to introduction of the new substance Vantris. The results of a multi-centre survey published in 2014 showed that reflux is corrected in more than 90% of cases after single PPC injection. Our results with PPC confirm a high level of reflux resolution.


CONCLUSIONS
Our data show that Vantris injection is a safe and effective procedure for treating all grades of VUR with good clinical outcome, and provides a higher and almost complete level of reflux resolution after first injection compared with Deflux.
Department of Paediatric Surgery and Urology, Medical University of Warsaw, Warsaw, Poland. Electronic address: swarchol@poczta.onet.pl.
Stanislaw
S
Warchol
Department of Paediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland.
Grazyna
G
Krzemien
Department of Paediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland.
Agnieszka
A
Szmigielska
Department of Paediatric Radiology, Medical University of Warsaw, Warsaw, Poland.
Przemyslaw
P
Bombinski
Department of Paediatric Radiology, Medical University of Warsaw, Warsaw, Poland.
Michal
M
Brzewski
Department of Paediatric Surgery and Urology, Medical University of Warsaw, Warsaw, Poland.
Teresa
T
Dudek-Warchol
D000180:Acrylic Resins; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003911:Dextrans; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid; D007223:Infant; D008297:Male; D014718:Vesico-Ureteral Reflux / Q000628:therapy*
D000180:Acrylic Resins; D003911:Dextrans; C530415:Vantris; C094535:deflux; D006820:Hyaluronic Acid
Deflux; Endoscopic correction of VUR; Vantris; Vesicoureteral reflux