581 DOUBLE HIT VERSUS OTHER INJECTION TECHNIQUES USING DEXTRANOMER/HYALURONIC ACID: DOES TECHNIQUE OR VOLUME MATTER?

Abstract

You have accessJournal of UrologyPediatrics: Imaging/Infections & Vesicoureteral Reflux1 Apr 2011581 DOUBLE HIT VERSUS OTHER INJECTION TECHNIQUES USING DEXTRANOMER/HYALURONIC ACID: DOES TECHNIQUE OR VOLUME MATTER? Daniel DaJusta, Nicol Bush, Song Zhang, and Warren Snodgrass Daniel DaJustaDaniel DaJusta Dallas, TX More articles by this author , Nicol BushNicol Bush Dallas, TX More articles by this author , Song ZhangSong Zhang Dallas, TX More articles by this author , and Warren SnodgrassWarren Snodgrass Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1391AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The optimal injection technique to correct vesicoureteral reflux using dextranomer/hyaluronic acid (Dx/HA) remains uncertain. We have previously published similar success rates using intra-orifice (IO) injection compared to hydrodistention implantation technique (HIT). In an effort to improve Dx/HA success, we combined HIT plus intra-orifice injection (Double HIT) and now evaluate if this technical modification resulted in higher reflux resolution. METHODS Since 2002, a single surgeon has prospectively maintained Dx/HA surgical outcomes in consecutive, non-selected refluxing patients using 4 successive injection techniques: traditional STING, IO, HIT, and then Double HIT. Patients lacking post-procedure cystogram and those with neurogenic bladder were excluded. Univariate and multivariate logistic regression analyses were used to evaluate reflux resolution rates at 12 weeks. Risk factors (covariates) included surgical techniques on an intention-to-treat basis, patient age, gender, reflux grade, injected volume, dysfunctional elimination syndrome, and orifice location. P-values < 0.05 were considered significant. RESULTS Of 400 patients, 342 (85.5%) underwent postoperative cystogram, of whom 295 (86.3%) were female. The number of patients with maximum reflux grades I–V, respectively, were 8 (2.3%), 162 (47.4%), 125 (36.6%), 34 (9.9%), and 13 (3.8%). A single Dx/HA injection resolved the reflux in 244 (71.4%). By technique, 129 (37.7%) patients underwent STING, 72 (21%) IO, 57 (16.7%) HIT, and 84 (24.6%) attempted Double HIT injections, with success rates of 65%, 73%, 70%, and 80%, respectively. Mean injected volumes per ureter were higher for double HIT than STING, IO, and HIT (0.77mL vs. 0.55, 0.50, 0.68, respectively, p<0.04). Despite overall 80% success with Double HIT, technique did not improve odds of reflux resolution when adjusted for other risk factors. On multivariate analysis, high grade IV–V reflux was the only statistically significant variable, increasing the odds of failure 2.7-fold (p=0.005, 95% CI 1.3–5.3). CONCLUSIONS Despite increased Dx/HA volumes, Double HIT technique did not improve odds of reflux resolution when adjusted for other risk factors, with an overall reflux resolution rate of 71.4% after a single Dx/HA injection. Multiple logistic regression revealed only grades IV–V reflux as a statistically significant predictor, increasing the risk of continued reflux after a single injection 2.7-fold. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e234 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel DaJusta Dallas, TX More articles by this author Nicol Bush Dallas, TX More articles by this author Song Zhang Dallas, TX More articles by this author Warren Snodgrass Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...