J Korean Med Sci.  2013 Jul;28(7):1060-1064. 10.3346/jkms.2013.28.7.1060.

Clinical Value of Persistent but Downgraded Vesicoureteral Reflux after Dextranomer/Hyaluronic Acid Injection in Children

• Baek M
• Kang MY
• Lee HE
• Park K
• Choi H

• KMID: 1777503
• DOI: http://doi.org/10.3346/jkms.2013.28.7.1060

Abstract

We aimed to investigate the clinical value of persistent but downgraded vesicoureteral reflux (VUR) after dextranomer/hyaluronic acid (Dx/HA) injection in children. The medical records of 128 children (195 ureters) who underwent Dx/HA injections for VUR were reviewed. The incidences of pre- and post-operative febrile urinary tract infections (UTIs) were analyzed in children with or without persistent VUR on voiding cystourethrography (VCUG) 3 months postoperatively. The surgical results of VUR persistent children who underwent a single additional injection were assessed. The VUR resolved completely in 100 ureters (51.3%), was persistent in 95 ureters, and newly developed in 2 ureters. The incidence of pre/post-operative febrile UTIs were 0.35 +/- 0.39 per year and 0.07 +/- 0.32 per year in VUR resolved children (P < 0.001), and 0.76 +/- 1.18 per year and 0.20 +/- 0.61 per year in VUR persistent children (P < 0.001). A single additional Dx/HA injection (44 ureters) resolved VUR in 29 ureters (65.9%), and also reduced the VUR to grade I in 7 ureters (15.9%), II in 4 (9.1%), and III in 4 (9.1%). Even in children with persistent VUR after Dx/HA injection, the incidence of febrile UTIs decreased markedly. The VUR grade significantly decreases after single additional Dx/HA injection.

Keyword

Vesico-Ureteral Reflux; Endoscopy; Pyelonephritis; Pediatrics

MeSH Terms

Antibiotic Prophylaxis
Child
Child, Preschool
Dextrans/*therapeutic use
Female
Fever/complications/epidemiology
Humans
Hyaluronic Acid/*therapeutic use
Incidence
Male
Retrospective Studies
Treatment Outcome
Urinary Tract Infections/complications/drug therapy/*epidemiology
Vesico-Ureteral Reflux/*drug therapy/surgery
Dextrans
Hyaluronic Acid

Figure

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  Fig. 1 Pre- and post-operative vesicoureteral reflux grade in children with persistent refluxing ureters. (A) Preoperative vesicoureteral reflux grade (n = 95). (B) Postoperative vesicoureteral reflux grade (n = 97). VUR, vesicoureteral reflux.

• 

  Fig. 2 Incidence of pre- and post-operative febrile urinary tract infection in children with persistent refluxing ureters (n = 75). (A) Incidence of preoperative febrile urinary tract infection. (B) Incidence of postoperative febrile urinary tract infection. UTI, urinary tract infection.

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  Fig. 3 Surgical results after additional single injection (n = 44). (A) Preoperative vesicoureteral reflux grade. (B) Vesicoureteral reflux grade three months postoperatively. (C) Vesicoureteral reflux grade after additional single injection. VUR, vesicoureteral reflux.

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