We aimed to investigate the clinical value of persistent but downgraded vesicoureteral reflux (VUR) after dextranomer/hyaluronic acid (Dx/HA) injection in children. The medical records of 128 children (195 ureters) who underwent Dx/HA injections for VUR were reviewed. The incidences of pre- and post-operative febrile urinary tract infections (UTIs) were analyzed in children with or without persistent VUR on voiding cystourethrography (VCUG) 3 months postoperatively. The surgical results of VUR persistent children who underwent a single additional injection were assessed. The VUR resolved completely in 100 ureters (51.3%), was persistent in 95 ureters, and newly developed in 2 ureters. The incidence of pre/post-operative febrile UTIs were 0.35 +/- 0.39 per year and 0.07 +/- 0.32 per year in VUR resolved children (P < 0.001), and 0.76 +/- 1.18 per year and 0.20 +/- 0.61 per year in VUR persistent children (P < 0.001). A single additional Dx/HA injection (44 ureters) resolved VUR in 29 ureters (65.9%), and also reduced the VUR to grade I in 7 ureters (15.9%), II in 4 (9.1%), and III in 4 (9.1%). Even in children with persistent VUR after Dx/HA injection, the incidence of febrile UTIs decreased markedly. The VUR grade significantly decreases after single additional Dx/HA injection.
Antibiotic Prophylaxis ; Child ; Child, Preschool ; Dextrans/*therapeutic use ; Female ; Fever/complications/epidemiology ; Humans ; Hyaluronic Acid/*therapeutic use ; Incidence ; Male ; Retrospective Studies ; Treatment Outcome ; Urinary Tract Infections/complications/drug therapy/*epidemiology ; Vesico-Ureteral Reflux/*drug therapy/surgery

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.
Administration, Intravesical ; Adolescent ; Child ; Child, Preschool ; Dextrans/*administration & dosage ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Hyaluronic Acid/*administration & dosage ; Infant ; Male ; Reproducibility of Results ; Treatment Outcome ; Ureter/*surgery ; Urologic Surgical Procedures/*methods ; Vesico-Ureteral Reflux/*drug therapy/ultrasonography

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.
Administration, Intravesical ; Adolescent ; Child ; Child, Preschool ; Dextrans/*administration & dosage ; Endoscopy ; Female ; Follow-Up Studies ; Humans ; Hyaluronic Acid/*administration & dosage ; Infant ; Male ; Reproducibility of Results ; Treatment Outcome ; Ureter/*surgery ; Urologic Surgical Procedures/*methods ; Vesico-Ureteral Reflux/*drug therapy/ultrasonography