Preliminary Results of Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid Copolymer in Children

Background: Endoscopic treatment with various bulking agents has been widely used as a therapy for vesicoureteral reflux (VUR), because it is simpler, less time-consuming, and less painful than traditional surgeries. The ideal bulking agent for the injection therapies must be easily injectable, volume- stable, biocompatible, non-antigenic, non-migratory and with durable results.Objective: To evaluate the preliminary results of endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid copolymer in children.Patients and Methods: Forty three patients with 66 refluxing renal unit (RRU), 23 (53.5%)male and 20(46.5%) female, with a mean age of 4.7 years (range: 4 months to 12 years), were treated endoscopically with Dextranomer/hyaluronic acid copolymer(Dx/HA) injection, in the Urological Department of Al-Sader Medical City/ Al-Najaf Al-Ashraf, and followed for a minimum of 12 months, VUR was unilateral in 20 (46.5%) and bilateral in 23 (53.5%) patients. Thereflux was from grade II to V in: 2 (3%), 20 (30.3%), 26 (39.4), 18 (27.3%) RRU respectively. The volume of Dx/HA injected was: 0.4 mL- 3mL per RRU with a mean of 1 mL.Results: All patients completed at least 12 months of follow up, reflux was disappeared in 45 RRU (68.1%) after just one injection, 21 RRU (31.9%) received a second injection, with reflux successfully disappeared in 12 RRU (57.1%) of the 21 RRU, and success rate of total group of RRU was 86.4%. Complications were: Two patients (4.6%) with 2 RRU (3%) develop ureteral obstruction, UTIs in 4 patients (9.3%) in the first 6 months postoperatively.Conclusions: The success rate shows that endoscopic treatment of VUR is very effective, and it can be considered the first line treatment option for VUR, with a low rate of complications.