Treatment of vesicoureteral reflux using endoscopic injection of nonanimal stabilized hyaluronic acid/dextranomer gel: initial experience in pediatric patients by a single surgeon.

OBJECTIVE: Endoscopic injection of nonanimal stabilized hyaluronic acid/dextranomer gel is an increasingly recognized treatment option for vesicoureteral reflux. The procedure is minor compared with open surgery and, when successful, avoids the need for long-term antibiotic prophylaxis. We present data from our first 18 months using nonanimal stabilized hyaluronic acid/dextranomer gel to treat children with vesicoureteral reflux.

PATIENTS AND METHODS: Pediatric patients aged < or = 15 years with uncomplicated primary vesicoureteral reflux were recruited for endoscopic treatment with nonanimal stabilized hyaluronic acid/dextranomer gel. A follow-up voiding cystourethrogram was scheduled at > or = 2 weeks after treatment, and vesicoureteral reflux resolution was defined as grade 0. Repeat nonanimal stabilized hyaluronic acid/dextranomer gel treatment was offered to patients with persistent vesicoureteral reflux.

RESULTS: Of 120 patients treated, 6 were lost to follow-up, and 7 were yet to undergo posttreatment voiding cystourethrogram. The 107 remaining patients (efficacy population) had a mean age of 4.1 years (range: 0.5-15.0), and the median reflux grade was 2 (range: 1-5). The mean time to follow-up voiding cystourethrogram was 9.7 weeks (range: 2-26). Vesicoureteral reflux was resolved in 82.2% of patients and 86.9% of ureters after initial endoscopic treatment with nonanimal stabilized hyaluronic acid/dextranomer gel. The overall reflux resolution rate for patients increased to 90.7% after a second treatment in 14 patients. Two patients reported postoperative flank pain, although this was mild and transient in nature. No other adverse events were reported. No patients underwent open surgery for vesicoureteral reflux.

CONCLUSIONS: Endoscopic treatment with nonanimal stabilized hyaluronic acid/dextranomer gel is effective in a high proportion of children with vesicoureteral reflux and, in our opinion, may be considered as a first-line treatment option.