Endoscopic treatment of grades IV and V vesicoureteral reflux with two bulking substances: Dextranomer hyaluronic acid copolymer versus polyacrylate polyalcohol copolymer in children ★★★

PurposeWe aimed at evaluating the efficacy and complications of two bulking substances: dextranomer/hyaluronic acid copolymer(Dx/Ha;Dexell®) versus polyacrylate polyalcohol copolymer(PPC;Vantris®) in subureteric injection treatment of children with high grades (grades IV-V) vesicoureteral reflux(VUR).MethodsData of patients undergoing endoscopic treatment of high grade VUR (January 2009–August 2015) were retrospectively investigated. Patients with high grade VUR caused by posterior urethral valve, duplex system, paraureteral diverticula and neurogenic bladder were excluded. Classical subureteric injection method (STING) was used. Seventy-three children (45 girls and 28 boys) who had 88 refluxing renal units (RRUs) with grades IV-V VUR (n = 64/n = 24) underwent endoscopic treatment using Dx/Ha (n = 63 RRUs) and PPC (n = 25 RRUs).ResultsMean age of patients in Dx/Ha and PPC groups were 6 (3) and 6 (3.75) year (p = 0.81), and volumes of these substances given were 1.3 (1) and 1 (0.5) mL (p = 0.003), respectively.Overall, for the first endoscopic injection, success rate of grades IV-V VUR per RRU was 53.9% with Dx/Ha, compared to 80% in PPC-injected group, (p = 0.024). Late ureterovesical junction obstruction developed only in one patient in PPC-injected group. No ureteral obstruction was observed in Dx/Ha-injected group.ConclusionsEndoscopic injection of PPC resulted in significantly higher success rate, compared to Dx/Ha in subureteric injection treatment of children with high grade VUR.However, the development of late ureterovesical junction obstruction should also be taken into account in PPC injection.