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    Korean J Urol. 2009 Jan;50(1):61-66. Korean.
    Published online Jan 31, 2009.
    https://doi.org/10.4111/kju.2009.50.1.61
    Copyright © 2009 The Korean Urological Association
    Original Article

    Risk Factors for Treatment Failure after Endoscopic Subureteral Injection of Dextranomer/Hyaluronic Acid Copolymer (Deflux®) for Vesicoureteral Reflux

    Dong Woo Lee, Kyung Mo Kang, Woo Seok Oh, Jae Soo Kim,1 and Sung Kwang Chung
      • Department of Urology, School of Medicine, Kyungpook National University, Korea.
      • 1Department of Urology, Daegu Fatima Hospital, Daegu, Korea.
    Received March 07, 2008; Accepted November 24, 2008.

    Abstract

    Purpose

    Endoscopic subureteral injection of dextranomer/hyaluronic acid copolymer (Deflux®) has become an established alternative to long-term antibiotic prophylaxis and open ureteral reimplantation for the management of vesicoureteral reflux (VUR) in children. We retrospectively evaluated the risk factors for treatment failure after endoscopic correction of VUR.

    Materials and Methods

    Between 2005 and 2007, 23 boys and 26 girls (total of 69 ureters) with VUR underwent endoscopic subureteral injection of Deflux® primarily. VUR was unilateral in 29 patients and bilateral in 20 patients. Of the 69 ureters, VUR was grade II to V in 13, 28, 20, and 8, respectively. Follow-up urinalysis and ultrasonography were performed 1 and 3 months after the procedure, and a voiding cystourethrogram was performed at 6 or 9 months postoperatively.

    Results

    Treatment failure was defined as persistent VUR of grade II or over grade II. Endoscopic correction failed in 22 of 69 refluxing ureters. Age, sex, laterality, number of preoperative urinary tract infections, time from diagnosis to operation, presence of renal scarring, and injection volume did not influence outcome. However, preoperative presence of voiding symptoms, high-grade reflux and hydronephrosis, and having a horseshoe or golf-hole shaped ureteral orifice had a negative influence on the treatment result by univariate analysis. Severe dilatation of the lower ureter was the only statistically significant factor by multivariate analysis.

    Conclusions

    Severity of lower ureteral dilatation is the most significant factor influencing the failure of endoscopic subureteral injection of Deflux®. Other factors significantly involved in failure are the presence of voiding symptoms, high-grade reflux and hydronephrosis, and a horseshoe or golf-hole shaped ureteral orifice. Success rates may improve if we carefully consider these influencing factors before choosing an operative method.

    Keywords
    Vesicoureteral reflux; Deflux®; Risk factors

    Tables

    Table 1
    Patients' characteristics and outcomes

    Table 2
    Multivariate analysis by logistic regression model

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    MeSH Terms
    Antibiotic Prophylaxis
    Child
    Cicatrix
    Dilatation
    Follow-Up Studies
    Humans
    Hydronephrosis
    Multivariate Analysis
    Replantation
    Retrospective Studies
    Risk Factors
    Treatment Failure
    Ureter
    Urinalysis
    Urinary Tract Infections
    Vesico-Ureteral Reflux
    Metrics
    Share
    Tables
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