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    Korean J Urol. 2009 Jan;50(1):51-56. Korean.
    Published online Jan 31, 2009.
    https://doi.org/10.4111/kju.2009.50.1.51
    Copyright © 2009 The Korean Urological Association
    Original Article

    Overall Outcomes and Factors Predicting the Success of Endoscopic Dextranomer/Hyaluronic Acid Copolymer Injection for Vesicoureteral Reflux

    Min Yong Kang, Dong-Soo Park, Yong Hyun Park, Jeong-Won Lee,1 Minki Baek,2 and Hwang Choi
      • Department of Urology, Seoul National University College of Medicine, Korea.
      • 1Department of Nuclear Medicine, Seoul National University College of Medicine, Korea.
      • 2Department of Urology, Konkuk University College of Medicine, Seoul, Korea.
    Received August 26, 2008; Accepted October 22, 2008.

    Abstract

    Purpose

    We aimed to evaluate the overall outcomes of endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for vesicoureteral reflux (VUR) and analyze the factors predicting success.

    Materials and Methods

    A total 99 patients (58 males, 41 females) and 154 refluxing ureter units were treated with a endoscopic Deflux injection for VUR. At 3 months, radioisotope-voiding cystograms were performed to evaluate treatment responsiveness; success was defined as a resolving of VUR to less than grade I. We evaluated various perioperative factors such as gender, operation age, preoperative antibiotics duration, urinary tract infection, relative renal function and cortical defect, preoperative VUR grade, maximal flow rate in uroflowmetry, laterality of reflux, voiding dysfunction, constipation, orifice shape and trabeculation, injection technique, injection volume, number of punctures, and learning curve.

    Results

    The overall success rate was 62.3% (96/154) in refluxing ureter units (50.5% in patients). According to grade of VUR, the success rate was 87.5% (8/9), 82.2% (37/45), 67.8% (38/56), 33.3% (13/39), and 16.7% (1/6) in grade I, II, III, IV, and V, respectively (p=0.001). In multivariate analysis, preoperative VUR grade and mound morphology were identified as predictive factors (p<0.05). No significant surgery-related complications developed.

    Conclusions

    Endoscopic Deflux injection for VUR was effective for grade I-III VUR, although the cure rate was low for grade IV-V. The factors predicting success were preoperative VUR grade and mound morphology.

    Keywords
    Vesico-ureteral reflux; Endoscopy; Deflux

    Tables

    Table 1
    The success rates and predictive factors in refluxing ureter units

    Table 2
    The success rates and predictive factors of Deflux injection in patients with vesicoureteral reflux

    References

      1. Perez-Brayfield M, Kirsch AJ, Hensle TW, Koyle MA, Furness P, Scherz HC. Endoscopic treatment with dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux. J Urol 2004;172:1614–1616.
      1. Khoury AE, Bagli DJ. Reflux and megaureter. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders; 2007. pp. 3462-3466.
      1. Lackgren G, Wahlin N, Skoldenberg E, Stenberg A. Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol 2001;166:1887–1892.
      1. Capozza N, Lais A, Nappo S, Caione P. The role of endoscopic treatment of vesicoureteral reflux: a 17-year experience. J Urol 2004;172:1626–1628.
      1. Yucel S, Gupta A, Snodgrass W. Multivariate analysis of factors predicting success with dextranomer/hyaluronic acid injection for vesicoureteral reflux. J Urol 2007;177:1505–1509.
      1. Altug U, Cakan M, Yilmaz S, Yalcinkaya F. Are there predictive factors for the outcome of endoscopic treatment of grade III-V vesicoureteral reflux with dextranomer/hyaluronic acid in children? Pediatr Surg Int 2007;23:585–589.
      1. Lavelle MT, Conlin MJ, Skoog SJ. Subureteral injection of Deflux for correction of reflux: analysis of factors predicting success. Urology 2005;65:564–567.
      1. Puri P, Chertin B, Velayudham M, Dass L, Colhoun E. Treatment of vesicoureteral reflux by endoscopic injection of dextranomer/hyaluronic acid copolymer: preliminary results. J Urol 2003;170:1541–1544.
      1. Smellie JM, Barratt TM, Chantler C, Gordon I, Prescod NP, Ransley PG, et al. Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial. Lancet 2001;357:1329–1333.
      1. O'Donnell B, Puri P. Treatment of vesicoureteral reflux by endoscopic injection of Teflon. Br Med J 1984;289:7–9.
      1. Yu RN, Roth DR. Treatment of vesicoureteral reflux using endoscopic injection of nonanimal stabilized hyaluronic acid/dextranomer gel: initial experience in pediatric patients by a single surgeon. Pediatrics 2006;118:698–703.
      1. Stenberg AM, Sundin A, Larsson BS, Lackgren G, Stenberg A. Lack of distant migration after injection of a 125-iodine labeled dextranomer based implant into the rabbit bladder. J Urol 1997;158:1937–1941.
      1. Stenberg A, Lackgren G. A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results. J Urol 1995;154:800–803.
      1. Puri P, Mohanan N, Menezes M, Colhoun E. Endoscopic treatment of moderate and high grade vesicoureteral reflux in infants using dextranomer/hyaluronic acid. J Urol 2007;178:1714–1716.
      1. Menezes MN, Puri P. The role of endoscopic treatment in the management of grade v primary vesicoureteral reflux. Eur Urol 2007;52:1505–1509.
      1. Park YH, Kim KM. Dextranomer/hyaluronic acid copolymer (Deflux®) injection for vesicoureteral reflux in children: the efficacy and safety. Korean J Urol 2007;48:620–626.
      1. Lee DW, Kim BS, Kim JS, Chung SK. The risk factors for recurrence of vesicoureteral reflux after subureteral dextranomer/hyaluronic acid injection. Korean J Urol 2007;48 Suppl 2:283.
      1. Kirsch AJ, Perez-Brayfield MR, Scherz HC. Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the Children's Hospitals of Atlanta experience. J Urol 2003;170:211–215.
      1. Herz D, Hafez A, Bagli D, Capolicchio G, McLorie G, Khoury A. Efficacy of endoscopic subureteral polydimethylsiloxane injection for treatment of vesicoureteral reflux in children: a North American clinical report. J Urol 2001;166:1880–1886.
      1. Dave S, Lorenzo AJ, Khoury AE, Braga LH, Skeldon SJ, Suoub M, et al. Learning from the learning curve: Factors associated with successful endoscopic correction of vesicoureteral reflux using dextranomer/hyaluronic acid copolymer. J Urol 2008;180:1594–1599.
      1. Elder JS, Diaz M, Caldamone AA, Cendron M, Greenfield S, Hurwitz R, et al. Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I. Reflux resolution and urinary tract infection. J Urol 2006;175:716–722.
      1. Chi A, Gupta A, Snodgrass W. Urinary tract infection following successful dextranomer/hyaluronic acid injection for vesicoureteral reflux. J Urol 2008;179:1966–1969.
    MeSH Terms
    Anti-Bacterial Agents
    Constipation
    Dextrans
    Endoscopy
    Humans
    Hyaluronic Acid
    Learning Curve
    Male
    Multivariate Analysis
    Punctures
    Ureter
    Urinary Tract Infections
    Vesico-Ureteral Reflux
    Metrics
    Share
    Tables
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