Endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer and dextranomer/hyaluronic acid in adults.

Akif Turk,Kadir Demir,Osman Celik,Fatih Tarhan,Erkin Saglam,Ahmet Selimoglu

doi:10.1590/s1677-5538.ibju.2014.03.12

Abstract

Aim of this study is to examine the effectiveness of dextranomer/hyaluronic acid copolymer and polyacrylate polyalcohol copolymer in endoscopic treatment of vesicoureteral reflux disease in adult patients with and without chronic renal failure. Thirty two patients (12 female, 20 male) with a total of 50 renal units were treated for vesicoureteral reflux. There were 26 (81%) chronic renal failure patients. The success of treatment was evaluated by voiding cystouretrography at 3rd and 12th months after subureteric injection. The persistence of reflux was considered as failure. Patients were divided into two groups according to injected material. Age, sex, grade of reflux and treatment results were recorded and evaluated. Reflux was scored as grade 1 in seven (14%), grade 2 in 16 (32%), grade 3 in 21 (42%) and grade 4 in six (12%) renal units. There was not patient with grade 5 reflux. Fourteen renal units (28%) were treated with dextranomer/hyaluronic acid copolymer (group 1) and 36 renal units (72%) were treated with polyacrylate polyalcohol copolymer (group 2). The overall treatment success was achieved at 40 renal units (80%). The treatment was successful at 11 renal units (79%) in group 1 and 29 renal units (81%) in group 2 (p = 0.71). There was not statistically significant difference between two groups with patients with chronic renal failure in terms of treatment success (p = 1.00). The effectiveness of two bulking agents was similar in treatment of vesicoureteral reflux disease in adult patients and patients with chronic renal failure.

Highlights

Treatment indications of vesicoureteral reflux (VUR) disease in children are well defined
Synthetic and absorbable dextranomer/ hyaluronic acid (DxHA) copolymer is the only material approved by FDA (The Food and Drug Administration) which is used in treatment of VUR disease
The aim of this study is to examine the effectiveness of absorbable synthetic DxHA copolymer and non-absorbable polyacrylate polyalcohol (PPC) copolymer tissue injection materials in endoscopic treatment of VUR disease in adult patients and patients with chronic renal failure

Summary

Introduction

Treatment indications of vesicoureteral reflux (VUR) disease in children are well defined. The recent surgical treatment modalities of VUR disease are open and endoscopic surgery. Synthetic and absorbable dextranomer/ hyaluronic acid (DxHA) copolymer is the only material approved by FDA (The Food and Drug Administration) which is used in treatment of VUR disease. This reduces migration probability and does not cause ibju | Treatment with polyacrylate polyalcohol and dextranomer allergic reactions. After two weeks of injection, hyaluronic acid is absorbed from the injection field and dextranomer microparticles are left [4]. It is the most used material worldwide [5]. The complications are minimal such as urinary obstruction (2.1%), macroscopic hematuria (12.5%), lumbar pain (6.2%) and urinary retention (4%) [7]

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