Urinary Tract Infection Following Successful Dextranomer/Hyaluronic Acid Injection for Vesicoureteral Reflux

Abstract

The incidence of symptomatic urinary tract infection following reflux resolution by endoscopic injection is unclear. We determined the occurrence of febrile and nonfebrile urinary tract infections, and factors relating to development of infection after reflux correction with dextranomer/hyaluronic acid injection. We identified 175 patients with more than 6 months of followup after successful dextranomer/hyaluronic acid injection by one of us (WS) to resolve vesicoureteral reflux. Of these patients data regarding post-injection symptomatic urinary tract infection could be obtained from parents and/or primary care physicians and urological records in 167, who comprised the study group. All patient reported infections were additionally verified by review of medical records. Univariate and multivariate logistic regression analyses were done, evaluating factors including gender, age, voiding dysfunction, reflux grade, unilateral vs bilateral reflux, number of pretreatment infections, number of infections within 12 months of injection and febrile vs nonfebrile urinary tract infection in predicting the likelihood of post-injection urinary tract infection. Urinary tract infection occurred in 159 patients (95%) before injection, and was febrile in 82%. With a median followup after reflux correction of 32 months (range 7 to 53) symptomatic infections developed in 40 children (24%), of which half were febrile. Multivariate analysis showed that the number of preoperative urinary tract infections best predicted the likelihood of infection after dextranomer/hyaluronic acid injection. Nearly half of the patients with febrile urinary tract infection undergoing followup cystography had recurrent reflux. Patients with more than 3 pre-injection infections were 8.5 times more likely than those with 1 pre-injection infection to have post-injection symptomatic urinary tract infection. Overall rates of symptomatic and febrile infections after dextranomer/hyaluronic acid reflux resolution were similar to those reported following ureteral reimplantation.