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The outcomes of two different bulking agents (dextranomer hyaluronic acid copolymer and polyacrylate-polyalcohol copolymer) in the treatment of primary vesico-ureteral reflux.

Taşkinlar H, Avlan D, Bahadir GB, Delibaş A, Nayci A - Int Braz J Urol (2016 May-Jun)

Bottom Line: VUR was resolved in 38 (66.6%) of 57 ureters and this equates to VUR correction in 33 (73.3%) of the 45 patients in Dx/HA group.In PPC group, overall success rate was 88.8% (of 40 in 45 ureters).Thus, Thus, this equates to VUR correction in 31 (88.5%) of the 35 patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Mersin University, School of Medicine, Mersin, Turkey.

ABSTRACT

Purpose: Subureteral injection of bulking agents in the endoscopic treatment of vesicoureteral reflux is widely accepted therapy with high success rates. Although the grade of vesicoureteric reflux and experience of surgeon is the mainstay of this success, the characteristics of augmenting substances may have an effect particularly in the long term. In this retrospective study, we aimed to evaluate the clinical outcomes of the endoscopic treatment of vesicoureteric reflux (VUR) with two different bulking agents: Dextranomer/hyaluronic acid copolymer (Dx/HA) and Polyacrylate polyalcohol copolymer (PPC).

Materials and methods: A total 80 patients (49 girls and 31 boys) aged 1-12 years (mean age 5.3 years) underwent endoscopic subureteral injection for correction of VUR last six years. The patients were assigned to two groups: subureteral injections of Dx/HA (45 patients and 57 ureters) and PPC (35 patients and 45 ureters). VUR was grade II in 27 ureters, grade III in 35, grade IV in 22 and grade V in 18 ureters.

Results: VUR was resolved in 38 (66.6%) of 57 ureters and this equates to VUR correction in 33 (73.3%) of the 45 patients in Dx/HA group. In PPC group, overall success rate was 88.8% (of 40 in 45 ureters). Thus, Thus, this equates to VUR correction in 31 (88.5%) of the 35 patients.

Conclusions: Our short term data show that two different bulking agent injections provide a high level of reflux resolution and this study revealed that success rate of PPC was significantly higher than Dx/HA with less material.

No MeSH data available.


Related in: MedlinePlus

After the injection of bulking material the needle was left in place for 1 minute.
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f01: After the injection of bulking material the needle was left in place for 1 minute.

Mentions: The indications for intervention were breakthrough urinary tract infection (UTI) while on antibiotic prophylaxis, progression of renal scarring and persistent VUR after at least one year of non-operative management. Dx/HA was used as a bulking agent from January 2007 to December 2010, whereas PPC was preferred as injection therapy from January 2011 to December 2014. All injections were performed under general anesthesia. Briefly, the patients were placed in the lithotomy position and the skin was prepared. Bladder was filled about to 70% of the estimated bladder capacity. 9.5Fr pediatric cystoscope with a 5Fr working channel was used for the procedure. The usual technique of subureteral injection is: first the ureteral orifice is determined and the needle is introduced submucosally under the ureteral orifice at 6 o’clock position. After the injection of the bulking material the needle is left in place for 1 minute (Figure-1). Patients were maintained on their antibiotic prophylaxis until the reflux was documented to be absent on postoperative VCUG 3 months after the injection. Patients who failed initial injection were offered a second injection or open surgery and a new VCUG was performed 3 months after the second injection or the surgery. Statistical analysis was performed by using SPSS statistical software, version 11.0 (SPSS Inc. Chicago, III. USA). Means, standard deviations and percentages were used for descriptive statistics. Group comparisons were performed using the independent t test for continuous data and chi-squared test for the categorical data. Values of P<0.05 were considered statistically significant.


The outcomes of two different bulking agents (dextranomer hyaluronic acid copolymer and polyacrylate-polyalcohol copolymer) in the treatment of primary vesico-ureteral reflux.

Taşkinlar H, Avlan D, Bahadir GB, Delibaş A, Nayci A - Int Braz J Urol (2016 May-Jun)

After the injection of bulking material the needle was left in place for 1 minute.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4920569&req=5

f01: After the injection of bulking material the needle was left in place for 1 minute.
Mentions: The indications for intervention were breakthrough urinary tract infection (UTI) while on antibiotic prophylaxis, progression of renal scarring and persistent VUR after at least one year of non-operative management. Dx/HA was used as a bulking agent from January 2007 to December 2010, whereas PPC was preferred as injection therapy from January 2011 to December 2014. All injections were performed under general anesthesia. Briefly, the patients were placed in the lithotomy position and the skin was prepared. Bladder was filled about to 70% of the estimated bladder capacity. 9.5Fr pediatric cystoscope with a 5Fr working channel was used for the procedure. The usual technique of subureteral injection is: first the ureteral orifice is determined and the needle is introduced submucosally under the ureteral orifice at 6 o’clock position. After the injection of the bulking material the needle is left in place for 1 minute (Figure-1). Patients were maintained on their antibiotic prophylaxis until the reflux was documented to be absent on postoperative VCUG 3 months after the injection. Patients who failed initial injection were offered a second injection or open surgery and a new VCUG was performed 3 months after the second injection or the surgery. Statistical analysis was performed by using SPSS statistical software, version 11.0 (SPSS Inc. Chicago, III. USA). Means, standard deviations and percentages were used for descriptive statistics. Group comparisons were performed using the independent t test for continuous data and chi-squared test for the categorical data. Values of P<0.05 were considered statistically significant.

Bottom Line: VUR was resolved in 38 (66.6%) of 57 ureters and this equates to VUR correction in 33 (73.3%) of the 45 patients in Dx/HA group.In PPC group, overall success rate was 88.8% (of 40 in 45 ureters).Thus, Thus, this equates to VUR correction in 31 (88.5%) of the 35 patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Mersin University, School of Medicine, Mersin, Turkey.

ABSTRACT

Purpose: Subureteral injection of bulking agents in the endoscopic treatment of vesicoureteral reflux is widely accepted therapy with high success rates. Although the grade of vesicoureteric reflux and experience of surgeon is the mainstay of this success, the characteristics of augmenting substances may have an effect particularly in the long term. In this retrospective study, we aimed to evaluate the clinical outcomes of the endoscopic treatment of vesicoureteric reflux (VUR) with two different bulking agents: Dextranomer/hyaluronic acid copolymer (Dx/HA) and Polyacrylate polyalcohol copolymer (PPC).

Materials and methods: A total 80 patients (49 girls and 31 boys) aged 1-12 years (mean age 5.3 years) underwent endoscopic subureteral injection for correction of VUR last six years. The patients were assigned to two groups: subureteral injections of Dx/HA (45 patients and 57 ureters) and PPC (35 patients and 45 ureters). VUR was grade II in 27 ureters, grade III in 35, grade IV in 22 and grade V in 18 ureters.

Results: VUR was resolved in 38 (66.6%) of 57 ureters and this equates to VUR correction in 33 (73.3%) of the 45 patients in Dx/HA group. In PPC group, overall success rate was 88.8% (of 40 in 45 ureters). Thus, Thus, this equates to VUR correction in 31 (88.5%) of the 35 patients.

Conclusions: Our short term data show that two different bulking agent injections provide a high level of reflux resolution and this study revealed that success rate of PPC was significantly higher than Dx/HA with less material.

No MeSH data available.


Related in: MedlinePlus