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Dextranomer-Hyaluronic Acid and Polyacrylate-Polyalcohol Copolymer are Equally Efficient for Endoscopic Treatment of Vesicoureteral Reflux in Children

Uros Bele, Dejan Bratus



Purpose: To compare the efficacy of two bulking agents, Dextranomer-Hyaluronic Acid (DxHA) and Polyacrylate-Polyalcohol Copolymer (PPC) used for endoscopic treatment of vesicoureteral reflux (VUR).

Materials and Methods: We endoscopically treated 125 patients (89 girls and 36 boys) diagnosed with VUR grades I-V, comprising a total of 174 refluxing ureters (RUs). Patients were categorized into two groups, 99 (56,9%) RUs were treated with DxHA (Group 1) and 75 (43,1%) RUs with PPC (Group 2). RUs treated with both bulking agents were excluded. The success of treatment was evaluated with postoperative VCUG at 3- and 12-months after the endoscopic procedure, only complete resolution of VUR was considered as treatment success. Data was collected and analyzed retrospectively. Statistical calculations were performed using the Chi-square test.

Results: After a single injection 80,0% (60/75) and 68,7% (68/99 RUs) of RUs resolved completely when treated with PPC and DxHA, respectively (P = .094). A second injection of PPC healed another 10 RUs (total 93,3%), whereas DxHA resolved additional 16 RUs (total 84,8%) (P = .097). A third injection was needed for 1 RU, treated with PPC and another 3 RUs with DxHA. Twelve months post-operatively, we achieved a total resolution rate of 94,7% (71/75 RUs) with PPC, while DxHA successfully treated 87,9% (87/99) of RUs (P = .125).

Conclusions: DxHA and PPC showed no statistically significant differences neither in the number of injections needed nor in the total success rate after 12 months of follow-up.


Tekgül S, Riedmiller H, Hoebeke P, et al. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012;62(3):534-542. doi:10.1016/j.eururo.2012.05.059

Lendvay TS, Sorensen M, Cowan CA, Joyner BD, Mitchell MM, Grady RW. The evolution of vesicoureteral reflux management in the era of dextranomer/hyaluronic acid copolymer: a pediatric health information system database study. J Urol. 2006;176(4 Pt 2):1864-1867. doi:10.1016/j.juro.2006.04.088

Corbetta JP, Bortagaray JI, Weller S, et al. The use of polyacrylate-polyalcohol copolymer hydrogel in the endoscopic treatment of primary vesicoureteral reflux in children. J Pediatr Surg. 2015;50(3):485-488. doi:10.1016/j.jpedsurg.2014.07.001

Matouschek E. [Treatment of vesicorenal reflux by transurethral teflon-injection (author’s transl)]. Urol Ausg A. 1981;20(5):263-264.

Garcia-Aparicio L, Rovira J, Blazquez-Gomez E, et al. Randomized clinical trial comparing endoscopic treatment with dextranomer hyaluronic acid copolymer and Cohen’s ureteral reimplantation for vesicoureteral reflux: long-term results. J Pediatr Urol. 2013;9(4):483-487. doi:10.1016/j.jpurol.2013.03.003

Chertin B, Kocherov S. Long-term results of endoscopic treatment of vesicoureteric reflux with different tissue-augmenting substances. J Pediatr Urol. 2010;6(3):251-256. doi:10.1016/j.jpurol.2009.10.011

Läckgren G, Wåhlin N, Sköldenberg E, Stenberg A. Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol. 2001;166(5):1887-1892.

Stredele RJF, Dietz H-G, Stehr M. Long-term results of endoscopic treatment of vesicoureteral reflux in children: comparison of different bulking agents. J Pediatr Urol. 2013;9(1):71-76. doi:10.1016/j.jpurol.2011.12.004

Lee EK, Gatti JM, Demarco RT, Murphy JP. Long-term followup of dextranomer/hyaluronic acid injection for vesicoureteral reflux: late failure warrants continued followup. J Urol. 2009;181(4):1869-1874; discussion 1874-1875. doi:10.1016/j.juro.2008.12.005

Ormaechea M, Paladini M, Pisano R, et al. Vantris, a biocompatible, synthetic, non-biodegradable, easy-to-inject bulking substance. Evaluation of local tissular reaction, localized migration and long-distance migration. Arch Esp Urol. 2008;61(2):263-268.

Chertin B, Abu Arafeh W, Kocherov S. Endoscopic correction of complex cases of vesicoureteral reflux utilizing Vantris as a new non-biodegradable tissue-augmenting substance. Pediatr Surg Int. 2014;30(4):445-448. doi:10.1007/s00383-014-3468-z

Sharifiaghdas F, Tajalli F, Otukesh H, Shamsabadi RH. Endoscopic correction of primary VUR by using polyacrylate polyalcohol copolymer (Vantris) in young girls: 2-Year follow-up. J Pediatr Urol. 2014;10(6):1032-1036. doi:10.1016/j.jpurol.2014.02.016

Kocherov S, Ulman I, Nikolaev S, et al. Multicenter survey of endoscopic treatment of vesicoureteral reflux using polyacrylate-polyalcohol bulking copolymer (Vantris). Urology. 2014;84(3):689-693. doi:10.1016/j.urology.2014.04.033

Elder JS, Shah MB, Batiste LR, Eaddy M. Part 3: Endoscopic injection versus antibiotic prophylaxis in the reduction of urinary tract infections in patients with vesicoureteral reflux. Curr Med Res Opin. 2007;23 Suppl 4:S15-S20. doi:10.1185/030079907X226230

Kirsch AJ, Perez-Brayfield MR, Scherz HC. Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the Children’s Hospitals of Atlanta experience. J Urol. 2003;170(1):211-215. doi:10.1097/01.ju.0000072523.43060.a0

Rubenwolf PC, Ebert A-K, Ruemmele P, Rösch WH. Delayed-onset ureteral obstruction after endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for treatment of vesicoureteral reflux in children: a case series. Urology. 2013;81(3):659-662. doi:10.1016/j.urology.2012.11.044

Mazzone L, Gobet R, González R, Zweifel N, Weber DM. Ureteral obstruction following injection of dextranomer/hyaluronic acid copolymer: an infrequent but relevant complication. J Pediatr Urol. 2012;8(5):514-519. doi:10.1016/j.jpurol.2011.10.002

Ormaechea M, Ruiz E, Denes E, et al. New Tissue Bulking Agent (Polyacrylate Polyalcohol) for Treating Vesicoureteral Reflux: Preliminary Results in Children. J Urol. 2010;183(2):714-718. doi:10.1016/j.juro.2009.10.047

Vandersteen DR, Routh JC, Kirsch AJ, et al. Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic Acid copolymer. J Urol. 2006;176(4 Pt 1):1593-1595. doi:10.1016/j.juro.2006.06.101

Alizadeh F, Mazdak H, Khorrami MH, Khalighinejad P, Shoureshi P. Postoperative ureteral obstruction after endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer (Vantris®). J Pediatr Urol. 2013;9(4):488-492. doi:10.1016/j.jpurol.2012.11.007

Menezes M, Mohanan N, Haroun J, Colhoun E, Puri P. New contralateral vesicoureteral reflux after endoscopic correction of unilateral reflux--is routine contralateral injection indicated at initial treatment? J Urol. 2007;178(4 Pt 2):1711-1713. doi:10.1016/j.juro.2007.03.177

Blais A-S, Morin F, Cloutier J, Moore K, Bolduc S. Efficacy of dextranomer hyaluronic acid and polyacrylamide hydrogel in endoscopic treatment of vesicoureteral reflux: A comparative study. Can Urol Assoc J J Assoc Urol Can. 2015;9(5-6):202-206. doi:10.5489/cuaj.2964

Taşkinlar H, Avlan D, Bahadir GB, Delibaş A, Nayci A. The outcomes of two different bulking agents (dextranomer hyaluronic acid copolymer and polyacrylate-polyalcohol copolymer) in the treatment of primary vesico-ureteral reflux. Int Braz J Urol Off J Braz Soc Urol. 2016;42(3):514-520.

Karakus SC, User İR, Kılıc BD, Akçaer V, Ceylan H, Ozokutan BH. The comparison of dextranomer/hyaluronic acid and polyacrylate-polyalcohol copolymers in endoscopic treatment of vesicoureteral reflux. J Pediatr Surg. 2016;51(9):1496-1500. doi:10.1016/j.jpedsurg.2016.02.092

DOI: http://dx.doi.org/10.22037/uj.v0i0.4462


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