Long-term results after endoscopic VUR-treatment using dextranomer / hyaluronic acid copolymer - 5-year experience in a single-center

Abstract

Background: A number of bulking agents have been used for the endoscopic correction of vesicoureteral reflux in children. We present our long-term results of endoscopic use of dextranomer/hyaluronic acid copolymer (Deflux(®)) for VUR treatment in children.

Patients and methods: Between 2004 and 2008, 21 children underwent endoscopic subureteral injection of Deflux(®) in 30 ureters as an outpatient procedure. Twelve children had unilateral reflux (2 duplicated systems) and nine had bilateral reflux. Median age was 5-years (6-months to 14.9-years). Six weeks postoperatively, a voiding cystourethrogram was performed. This study examined the disappearance of VUR and urinary tract infection (UTI) in the long-term follow-up as well as QoL (questionnaire of the parents).

Results: No intra- or postoperative complications had been noticed. In 25 ureters (83%), VCUG showed no VUR 6-weeks postoperatively. Three children received a 2nd injection (two successful). After a median follow-up of 2.5 years, 27 ureters in 17 children (90%) had no urinary tract infection and VUR. The questionnaire results in regard to quality of life (QoL) were very good in the successfully treated children and the parents would choose the same treatment option again.

Conclusion: Subureteral injection of Deflux(®) for children with VUR is an effective treatment option with a low complication rate.

Keywords: dextranomer/hyaluronic acid; health-related quality of life; minimally invasive therapy; subureteral injection; vesicoureteral reflux.

Fig. 1

Needle placement in endoscopic treatment of VUR. Injection spots 1 and 2 correspond to the intramural dorsal injection spots, injection spot 3 corresponds to the subureteral injection at 6 o'clock.