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Effectiveness of dextranomer/hyaluronic acid copolymer injection in pediatric population with vesicoureteric reflux having associated congenital anomalies: our experience and detailed review

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Abstract

Background

Successful resolution of vesicoureteric reflux (VUR) via endoscopic methods has been achieved in the last two decades. After investigating multiple agents, Deflux is being used at most of the centers. We have studied the safety and efficacy of Deflux in our patients having VUR with complex urogenital anomalies and reviewed the literature.

Methods

We have retrospectively collected the data of 28 children with the diagnosis of VUR, treated endoscopically over a period of 3 years. The data were collected from the hospital records and analyzed. The data included demographics, associated anomalies, grades of reflux, number of ureters affected, treatment given, number of sittings required, initial findings of micturating cystourethrograms, follow-up cystogram findings, and details of the procedure done. The data were evaluated for overall success rates in children with associated anomalies.

Results

Among the 28 patients, 22 children with 33 affected ureter units having associated anomalies (secondary VUR) were included in the study, with 18 boys and 4 girls. Six children having primary VUR and not associated with other congenital anomalies were excluded. The reflux was unilateral in 10 (45.45%) children and bilateral in 12 (54.54%) children. Reflux was Grade II in 11 (33.33%), Grade III in 9 (27.27%), Grade IV in 2 (6.06%), and Grade V in 11 (33.33%) of the 33 ureters. After the first injection of Deflux, complete resolution was observed in 28 (84.84%) ureters and 5 (15.15%) had partial resolution of the VUR at 3-month follow-up. At 1 year of the first injection, complete resolution was achieved in 32 (96.96%) ureters and 1 (3.03%) ureter still had persistent Grade IV reflux, for which he had undergone ureteric reimplantation.

Conclusions

We have observed that by endoscopic method reflux resolution was achieved in 84.84% after 1st and 96% children after 2nd injection. So based on our experience, we recommend the Deflux procedure as the primary treatment modality for VUR even in patients with associated complex urological anomalies and bladder dysfunction.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, [Praveen Mathur]. The data are not publicly available due to institutional protocol and government restrictions.

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Funding

No external source of funding was involved in the study.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Sawai Man Singh Medical College, Jaipur, India

    Sahaj Prajapati, Ramesh Chand Tanger, Ashish Paliwal, Priyanka Mittal & Praveen Mathur

  2. Department of Pediatric Surgery, Gajra Raja Medical College, Gwalior, India

    Vinay Mathur

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  1. Sahaj Prajapati
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  2. Vinay Mathur
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  3. Ramesh Chand Tanger
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  4. Ashish Paliwal
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  5. Priyanka Mittal
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  6. Praveen Mathur
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Correspondence to Praveen Mathur.

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Ethical approval was waived in view of the retrospective nature of the study. All patients were managed and treated as per standard institutional protocol.

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Written and informed consent has been obtained from the parents of all the subjects.

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Prajapati, S., Mathur, V., Tanger, R.C. et al. Effectiveness of dextranomer/hyaluronic acid copolymer injection in pediatric population with vesicoureteric reflux having associated congenital anomalies: our experience and detailed review. J Ped Endosc Surg 6, 71–76 (2024). https://doi.org/10.1007/s42804-024-00225-z

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  • DOI: https://doi.org/10.1007/s42804-024-00225-z

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