Endoscopic Treatment Of Vesicoureteral Reflux With Dextranomer/Hyaluronic Acid In Children

Main Category: Pediatrics / Children's Health
Also Included In: Urology / Nephrology
Article Date: 17 Oct 2008 - 3:00 PDT

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UroToday.com - A study by Dr. Wolfgang H. Cerwinka and his colleagues out of Emory University in Atlanta evaluated the different types of injectable agents, techniques, success rates, complications and future applications of endoscopic treatment of vesicoureteral reflux in children including the present current indications to perform the procedure.

The review article showed that the endoscopic method for achieving one of the highest success rates is what is referred to as double hydrodistention implantation technique also known as the HIT technique. The injectable agent most commonly utilized today in pediatric urology with the highest success rate and safety and efficacy is Deflux, which is a dextranomer/hyaluronic acid copolymer. Overall they found that cure rates can be greater than 85% for primary vesicoureteral reflux while success rates for more complicated VUR are significantly lower. The major advantage of the endoscopic technique is the avoidance of open or laparoscopic surgery. The convalescence and morbidity rates are much lower. The review article concluded that endoscopic injection is emerging as a treatment of choice for vesicoureteral reflux in children.

The one thing that I found interesting in this review article is that the majority of studies evaluated did not incorporate a very long term follow-up. There were a total of 6 of the 19 studies that seemed to have a mean follow-up of more than one year. One has to be wary of the longevity of the copolymer when the majority of studies have less than one year follow-up with a mean of only months. We find it interesting at our institution that even though Deflux is implemented, our overall numbers of reimplantations performed has not changed over the past 15 years. Although the percentage seems lower, the absolute number is unchanged.

Cerwinka WH, Scherz HC, Kirsch AJ
Adv Urol. 2008:513854
doi:10.1155/2008/513854

Written by UroToday.com Medical Editor Pasquale Casale, MD

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