The treatment of vesicoureteral reflux in children by endoscopic sub-mucosal intra-ureteral injection of dextranomer/hyaluronic acid: A case-series, multi-centre study
Background: Vesicoureteral reflux is a risk factor for progressive renal damage. In addition to long-term antibiotic prophylaxis and open surgical re-implantation, endoscopic sub-mucosal intra-ureteral injection of implant material is a therapeutic alternative that gained a world-wide preference....
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| Format: | Article |
| Language: | English |
| Published: |
Electronic Physician
2017-04-01
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| Series: | Electronic Physician |
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| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459285/ |
| Summary: | Background: Vesicoureteral reflux is a risk factor for progressive renal damage. In addition to long-term
antibiotic prophylaxis and open surgical re-implantation, endoscopic sub-mucosal intra-ureteral injection of
implant material is a therapeutic alternative that gained a world-wide preference.
Objective: The aim of this study was to determine the effectiveness and safety of the implant material,
dextranomer/hyaluronic acid, in a cohort of Saudi children with vesicoureteral reflux.
Methods: In this case-series study, 61 patients with vesicoureteral reflux, who were 7 months to 10 years old
(mean age 2.6 years), underwent sub-mucosal intra-ureteral injection of dextranomer/hyaluronic acid at our
institutions in the period from October 2003 to October 2013. The operative protocol was the same in all
institutions. Dextranomer/hyaluronic acid was injected submucosally within the intramural ureter (modified
STING). Renal ultrasonography was performed to detect the presence of hydronephrosis. At 6 weeks’
fluoroscopic voiding cystourethrograms were used to evaluate the success of the technique. Data were analysed
by SPSS version 19 using Pearson Chi square, Fisher's Exact and Cramér's V test.
Results: Reflux was corrected in 44 patients out of 61 (72.13%) and in 60 (75.00%) out of 80 ureteric units.
Statistically, there was no significant difference (p>0.05) in success rate of the technique according to gender, age
group and unilateral vs. bilateral cases. The success rate was significantly (p=0.025) higher in the lower grades (IIII)
(87.50%) compared to grade IV (73.53%) and grade V (50.00%). No complications related to the technique
were reported. The technique had failed in 17 patients (27.87%) or 20 ureters (25.00%). These cases underwent
open surgery.
Conclusion: Sub-mucosal intra-ureteral implantation with dextranomer/hyaluronic acid by the modified STING
technique is a simple, safe and effective outpatient procedure for vesicoureteral reflux |
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| ISSN: | 2008-5842 2008-5842 |