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KMID : 1218220090010010041
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Korean Journal of Pediatric Urology
2009 Volume.1 No. 1 p.41 ~ p.45
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Experience of Subureteral Dextranomer/Hyaluronic Acid Copolymer (Defluxⓡ) Injection Treatment in Children with Vesicoureteral Reflux
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Oh Jong-Jin
Jee Sang Hyun
Hong Young-Kwon
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Abstract
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Purpose: We assessed the results of endoscopic subureteral Dextranomer/ Hyaluronic acid copolymer (Defluxⓡ) injection treatment in children with vesicoureteral reflux.
Patients and Methods: Between September 2006 and December 2007, a total of 30 (51 renal units) VUR patients underwent subureteral Defluxⓡ injection treatment. All the patients were postoperatively assessed by ultrasound and voiding cystourethrography (VCUG) to evaluate any complication and the result of treatment.
Results: The mean follow-up period was 5.9 months (range 3-17). Of the 51 refluxing ureters, 14 were cured (27.5%) and 26 were improved (50.9%) after treatment. Cure rates by ascending grade were 100%, 0%, 36%, 18%, 0% after 1st trial with Defluxⓡ. All of two grade I VURs were cured (100%). Of two grade II VURs, one was improved (50.0%) and the other was persistent (50.0%). Of 22 grade III VURs, eight were cured (36.4%), 12 improved (54.5%), and two were persistent (9.1%). Of 22 grade IV VURs, four were cured (18.2%), 11 improved (50.0%), and seven were persistent (31.8%). Of three grade V VURs, none was cured, two improved (66.7%), and one was persistent (33.3%). There was no significant complication associated with this procedure. All of the cured patients had sterile urine even without prophylactic antibiotics, and none of the patients with bacteriuria after the procedure proved to be cured.
Conclusions: An endoscopic subureteral Defluxⓡ injection can be used as the 1st line of therapy for VUR because it is a safe procedure without causing any significant complication. Downgrading was encountered in more than half of the cases. However, the cure rate was not so high probably due in some part to the fact that this study was our initial experience. Additional injection trial after failed initial injection is worthy of consideration. Postoperative bacteriuria is thought to be a significant factor to predict the result of the operation.
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KEYWORD
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Deflux, Injection, Vesico-Ureteral reflux
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