Vol. 42 (3): 514-520, May – June, 2016
The outcomes of two different bulking agents (dextranomer hyaluronic acid copolymer and polyacrylate-polyalcohol copolymer) in the treatment of primary vesico-ureteral reflux
Hakan Taşkinlar 1, Dincer Avlan 1, Gokhan Berktug Bahadir 2, Ali Delibaş 1, Ali Nayci 1
1 Department of Pediatric Surgery, Mersin University, School of Medicine, Mersin, Turkey; 2 Department of Pediatric Nephrology, Mersin University, School of Medicine, Mersin, Turkey
Purpose: Subureteral injection of bulking agents in the endoscopic treatment of ve¬sicoureteral reflux is widely accepted therapy with high success rates. Although the grade of vesicoureteric reflux and experience of surgeon is the mainstay of this suc¬cess, the characteristics of augmenting substances may have an effect particularly in the long term. In this retrospective study, we aimed to evaluate the clinical outcomes of the endoscopic treatment of vesicoureteric reflux (VUR) with two different bulking agents: Dextranomer/hyaluronic acid copolymer (Dx/HA) and Polyacrylate polyalco¬hol copolymer (PPC). Materials and Methods: A total 80 patients (49 girls and 31 boys) aged 1-12 years (mean age 5.3 years) underwent endoscopic subureteral injection for correction of VUR last six years. The patients were assigned to two groups: subureteral injections of Dx/ HA (45 patients and 57 ureters) and PPC (35 patients and 45 ureters). VUR was grade II in 27 ureters, grade III in 35, grade IV in 22 and grade V in 18 ureters. Results: VUR was resolved in 38 (66.6%) of 57 ureters and this equates to VUR correc¬tion in 33 (73.3%) of the 45 patients in Dx/HA group. In PPC group, overall success rate was 88.8% (of 40 in 45 ureters). Thus, Thus, this equates to VUR correction in 31 (88.5%) of the 35 patients. Conclusions: Our short term data show that two different bulking agent injections pro¬vide a high level of reflux resolution and this study revealed that success rate of PPC was significantly higher than Dx/HA with less material.
Keywords: Vesico-Ureteral Reflux; Hyaluronic Acid; Pyran Copolymer; Therapeutics