PDF icon Download PDF
Eur J Pediatr Surg 2011; 21(5): 299-303
DOI: 10.1055/s-0031-1279700
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Hyaluronic Acid/Dextranomer Gel Implantation is Effective as First-Line Treatment of Vesicoureteral Reflux (VUR) in Children: A Single Centre Experience

F.-M. Häcker1 , M. Frech-Dörfler1 , M. von Rotz1 , C. Rudin2
  • 1University Children's Hospital Basel, Department of Pediatric Surgery, Basel, Switzerland
  • 2University Children's Hospital, Pediatric Nephrology, Basel, Switzerland
Further Information

Publication History

received February 25, 2011

accepted after revision April 16, 2011

Publication Date:
17 June 2011 (online)

Also available ateRef
   Permissions and Reprints
Preview

Abstract

Purpose: Aim of the study was to analyse the success rate of endoscopic treatment (ET) using Dx/HA for primary vesicoureteral reflux (VUR) in children and to assess the incidence of postoperative urinary tract infections (UTIs).

Methods: We retrospectively reviewed the charts of 103 children with VUR grade II-V who underwent ET, including children with additional urogenital malformations. Outcomes were verified with voiding cystourethrography (VCUG) and periodical urinalysis.

Results: 103 children with a total of 174 ureters underwent ET. 71 patients presented with bilateral VUR. Additional malformations were: duplex ureters (19 patients), posterior urethral valves (PUV) (12 patients), diverticulum (4 patients), neurogenic bladder and ectopic orifice. VUR grade was II in 52, III in 74, IV in 41 and V in 7 ureters, respectively. Postoperative VCUG demonstrated no VUR in 140 ureters (80%) and diminished VUR grade in an additional 18 ureters (total 91%). After a second ET, VCUG was negative in 28 ureters. The overall success rate was 98%. 30 patients had had more than 3 febrile and 67 patients had had 1–3 febrile UTIs before ET. 4 out of 103 patients (3.9%) had 1 febrile UTI within the first year of follow-up. Serious complications after ET were not noted.

Conclusion: ET is effective at eliminating VUR in children, even in patients with high-grade reflux, as well as in patients with VUR and additional malformations. Early intervention may reduce the incidence of UTIs and prevent long-term renal damage.

Key words

vesicoureteral reflux - endoscopic injection - dextranomer gel/hyaluronic acid - urinary tract infection - children

References

  • 1 Wheeler D, Vimalachandra D, Hodson E. et al . Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomized controlled trials.  Arch Dis Child. 2003;  88 688-694
    Search in Google Scholar
  • 2 Al-Sayyad AJ, Pike JG, Leonard MP. Can prophylactic antibiotics safely be discontinued in children with vesicoureteral reflux?.  J Urol. 2005;  174 1587-1589
    Search in Google Scholar
  • 3 Matouschek E. Die Behandlung des vesikorenalen Refluxes durch transurethrale Einspritzung von Teflonpaste.  Urologe A. 1981;  20 263-264
    Search in Google Scholar
  • 4 Frey P, Jenny P, Herzog B. Endoscopic subureteric collagen injection (SCIN): a new alternative treatment of vesicoureteric reflux in children.  Pediatr Surg Int. 1991;  6 287-294
    Search in Google Scholar
  • 5 Stenberg A, Läckgren G. A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short term clinical results.  J Urol. 1995;  154 800-803
    Search in Google Scholar
  • 6 Doerfler M, Haecker F-M, Jenny P. 10 Jahre SCIN am Universitäts-Kinderspital Basel.  Monatsschr Kinderheilkd. 2005;  153 (Suppl 2): S344
    Search in Google Scholar
  • 7 . Medical versus surgical treatment of primary vesicoureteral reflux: a prospective international reflux study in children.  J Urol. 1981;  125 277-283
    Search in Google Scholar
  • 8 Sjöström S, Sillen U, Bachelard M. et al . Spontaneous resolution of high grade infantile vesicoureteral reflux.  J Urol. 2004;  172 694-699
    Search in Google Scholar
  • 9 Schwab CW, Wu HY, Selman H. et al . Spontaneous resolution of vesicoureteral reflux: a 15-year perspective.  J Urol. 2002;  168 2594-2599
    Search in Google Scholar
  • 10 Lavalle MT, Conlin MJ, Skoog SJ. Subureteral injection of Deflux for correction of reflux: Analysis of factors predicting success.  Urology. 2005;  65 564-567
    Search in Google Scholar
  • 11 Garin EH, Olavarria F, Nieto VG. et al . Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study.  Pediatrics. 2006;  117 626-632
    Search in Google Scholar
  • 12 Roussey-Kesler G, Gadjos V, Idres N. et al . Antibibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study.  J Urol. 2008;  179 674-679
    Search in Google Scholar
  • 13 Elder JS, Peters CA, Arant BS. et al . Pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children.  J Urol. 1997;  157 1846-1851
    Search in Google Scholar
  • 14 Stenberg A, Läckgren G. Treatment of vesicoureteral reflux in children using stabilized non-animal hyaluronic acid/dextranomer gel (NASHA/DX): A long-term observational study.  J Pediatr Urol. 2007;  3 80-85
    Search in Google Scholar
  • 15 O’Donnell B, Puri P. Treatment of vesicoureteral reflux by endoscopic injection of Teflon.  Br Med J. 1984;  289 7-9
    Search in Google Scholar
  • 16 Chertin B, Kocherov S. Long-term results of endoscopic treatment of vesicoureteric reflux with different tissue-augmenting substances.  J Pediatr Urol. 2010;  6 251-256
    Search in Google Scholar
  • 17 Läckgren G, Wählin N, Sköldenberg E. et al . Endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid copolymer is effective in either double or a small kidney.  J Urol. 2003;  170 1551-1555
    Search in Google Scholar
  • 18 Dawrant MJ, Mohanan N, Puri P. Endoscopic treatment for high grade vesicoureteral reflux in infants.  J Urol. 2006;  176 1847-1850
    Search in Google Scholar
  • 19 Puri P, Pirker M, Mohanan N. et al . Subureteral dextranomer/hyaluronic acid injection as first line treatment in the management of high grade vesicoureteral reflux.  J Urol. 2006;  176 1856-1860
    Search in Google Scholar
  • 20 Puri P, Mohanan N, Menezes M. et al . Endoscopic treatment of moderate and high grade vesicoureteral reflux in infants using dextranomer/hyaluronic acid.  J Urol. 2007;  178 1714-1717
    Search in Google Scholar
  • 21 Molitierno JA, Scherz HC, Kirsch AJ. Endoscopic injection of dextranomer hyaluronic acid copolymer for the treatment of vesicoureteral reflux in duplex ureters.  J Pediatr Urol. 2008;  4 372-376
    Search in Google Scholar
  • 22 Routh JC, Imman BA, Reinberg Y. Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review.  Pediatrics. 2010;  125 (5) 1010-1019
    Search in Google Scholar
  • 23 Kirsch AJ, Perez-Brayfield M, Smith EA. et al . The modified STING procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter.  J Urol. 2004;  171 2413-2416
    Search in Google Scholar
  • 24 Wadie GM, Tirabassi MV, Courtney RA. et al . The Deflux procedure reduces the incidence of urinary tract infections in patients with vesicoureteral reflux.  J Laparoendosc Adv Surg Tech A. 2007;  17 353-359
    Search in Google Scholar
  • 25 Elmore JM, Kirsch AJ, Heiss EA. et al . Incidence of urinary tract infections in children after successful ureteral reimplantation versus endoscopic dextranomer/hyaluronic acid implantation.  J Urol. 2008;  179 2364-2368
    Search in Google Scholar
  • 26 Sedberry-Ross S, Rice DC, Pohl HG. et al . Febrile urinary tract infections in children with an early negative voiding cystourethrogram after treatment of vesicoureteral reflux with dextranomer/hyaluronic acid.  J Urol. 2008;  180 1605-1610
    Search in Google Scholar

Correspondence

Dr. Frank-Martin HäckerMD 

University Children's Hospital

Basel

Department of Pediatric

Surgery

P. O. Box

Spitalstraße 33

CH-4031 Basel

Switzerland

Phone: +41 61 685 52 39

Fax: +41 61 685 50 11

Email: frankmartin.haecker@ukbb.ch