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Eur J Pediatr Surg 2011; 21(5): 299-303
DOI: 10.1055/s-0031-1279700
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Hyaluronic Acid/Dextranomer Gel Implantation is Effective as First-Line Treatment of Vesicoureteral Reflux (VUR) in Children: A Single Centre Experience

F.-M. Häcker1 , M. Frech-Dörfler1 , M. von Rotz1 , C. Rudin2
  • 1University Children's Hospital Basel, Department of Pediatric Surgery, Basel, Switzerland
  • 2University Children's Hospital, Pediatric Nephrology, Basel, Switzerland
Further Information

Publication History

received February 25, 2011

accepted after revision April 16, 2011

Publication Date:
17 June 2011 (online)

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Abstract

Purpose: Aim of the study was to analyse the success rate of endoscopic treatment (ET) using Dx/HA for primary vesicoureteral reflux (VUR) in children and to assess the incidence of postoperative urinary tract infections (UTIs).

Methods: We retrospectively reviewed the charts of 103 children with VUR grade II-V who underwent ET, including children with additional urogenital malformations. Outcomes were verified with voiding cystourethrography (VCUG) and periodical urinalysis.

Results: 103 children with a total of 174 ureters underwent ET. 71 patients presented with bilateral VUR. Additional malformations were: duplex ureters (19 patients), posterior urethral valves (PUV) (12 patients), diverticulum (4 patients), neurogenic bladder and ectopic orifice. VUR grade was II in 52, III in 74, IV in 41 and V in 7 ureters, respectively. Postoperative VCUG demonstrated no VUR in 140 ureters (80%) and diminished VUR grade in an additional 18 ureters (total 91%). After a second ET, VCUG was negative in 28 ureters. The overall success rate was 98%. 30 patients had had more than 3 febrile and 67 patients had had 1–3 febrile UTIs before ET. 4 out of 103 patients (3.9%) had 1 febrile UTI within the first year of follow-up. Serious complications after ET were not noted.

Conclusion: ET is effective at eliminating VUR in children, even in patients with high-grade reflux, as well as in patients with VUR and additional malformations. Early intervention may reduce the incidence of UTIs and prevent long-term renal damage.

Key words

vesicoureteral reflux - endoscopic injection - dextranomer gel/hyaluronic acid - urinary tract infection - children

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Correspondence

Dr. Frank-Martin HäckerMD 

University Children's Hospital

Basel

Department of Pediatric

Surgery

P. O. Box

Spitalstraße 33

CH-4031 Basel

Switzerland

Phone: +41 61 685 52 39

Fax: +41 61 685 50 11

Email: frankmartin.haecker@ukbb.ch

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