Abstract
Introduction: Dextranomer/hyaluronic (Dx/HA) acid is the only tissue-augmenting agent approved by the Food and Drug Administration (FDA) for the vesicoureteral reflux (VUR) treatment. Objectives: We aimed to evaluate short-term outcomes of the Dx/HA in patients who had undergone subureteric injection. Patients and Methods: In this study, 30 patients with VUR diagnosis who had indications for open surgery were enrolled in the study. Patients underwent subureteric Dx/HA injection. Additionally patients underwent a one-year follow up period, subsequently. Follow up included urine analysis, urine cultures and kidney and urinary tract ultrasonography study. Results: Of a total 30 patients, 8 patients (27%) were male and 22 patients (73%) were female. The mean age of patients was 25.19 ± 0.70 months. Postoperative VUR resolution was observed in 28 patients (93.3%). Moreover, during one year follow up, urinary tract infection (UTI) was not reported in patients. However, recurrent VUR was detected in 8 patients (27%) during ultrasonography follow up. Analysis showed no significant difference of recurrence in VUR between males and females (P = 0.285) and VUR severity (P = 0.1). There was a significant relationship between recurrent UTI history before intervention and VUR recurrence after subureteric injection (P = 0.007). Conclusion: Dx/HA acid subureteric injection provides acceptable resolution rate among VUR patients, but its biodegradability causes VUR recurrence during one-year follow up.
Highlights
Dextranomer/hyaluronic (Dx/HA) acid is the only tissue-augmenting agent approved by the Food and Drug Administration (FDA) for the vesicoureteral reflux (VUR) treatment
Open surgery is still considered as gold standard for VUR treatment, STING has several advantages including simplicity, safety, quickness with low aggression which can provide an alternative treatment for open surgery [17,18]
Dextranomer/hyaluronic acid copolymer (Dx/HA) (Deflux) was the first tissue augmenting substance that was approved by the Food and Drug Administration to be used in VUR [19,20]
Summary
Dextranomer/hyaluronic (Dx/HA) acid is the only tissue-augmenting agent approved by the Food and Drug Administration (FDA) for the vesicoureteral reflux (VUR) treatment. During one year follow up, urinary tract infection (UTI) was not reported in patients. Conclusion: Dx/HA acid subureteric injection provides acceptable resolution rate among VUR patients, but its biodegradability causes VUR recurrence during one-year follow up. Since 1984, O’Donnell and Puri popularized endoscopic sub-ureteral transurethral injection (STING) modality for VUR treatment It has become one of the most attractive and first line therapy for children with VUR due to its high success rate, minimum aggression and few complications [13,14,15,16]. Several studies reported the high rate of VUR recurrence in patients who had undergone STING by Dx/HA at long-term follow up, especially in patients suffering from high-grade VUR [22]
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