Endoscopic injection therapy

Kim, Sang Woon; Lee, Yong Seung

doi:10.4111/icu.2017.58.s1.s38

Cited by 23 publications

(35 citation statements)

References 69 publications

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“…At our institution, patient success rates >90% had been achieved after 200 cases and were reported in 2008 (12). There is also an individual learning curve as the surgeon learns proper needle placement and injection technique in combination with visual and tactile cues (30).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Clinical Outcomes and Parental Satisfaction After Dextranomer/Hyaluronic Acid (Dx/HA) Injection for Primary Vesicoureteral Reflux

et al. 2019

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Purpose: Endoscopic dextranomer/hyaluronic acid (Dx/HA) injection is a common treatment for vesicoureteral reflux (VUR) with excellent reported short-term clinical success rates. Long-term outcomes are less well-defined. We assessed long-term outcomes and parental satisfaction after Dx/HA injection for primary VUR with >5-year follow-up.Materials and Methods: Families of all patients who underwent Dx/HA injection for primary VUR at our institution between 2008 and 2012 were contacted for telephone interview. Data collected by phone included parental satisfaction and presence and severity of UTIs pre-operatively and post-operatively. Patient demographics, radiographic VUR data, need for secondary surgery, and surgical indications were obtained through chart review.Results: Five hundred and seventy-five patients underwent Dx/HA injection for primary VUR between 2008 and 2012. Ninety-nine (17.2%) of these patients' parents were successfully contacted and interviewed. Median follow-up time from surgery to survey was 8.4 (IQR 6.8–9.6) years. Secondary surgery was performed in 13/99 (13.1%), most commonly repeat Dx/HA injection. Seven patients (7.1%) underwent secondary Dx/HA injection for persistent VUR without UTIs at a median of 0.35 (IQR 0.33–0.77) years post-operatively. Five patients (5.1%) underwent Dx/HA injection (n = 3) or ureteral reimplantation (n = 2) for VUR with febrile UTIs (fUTIs) at a median of 2.2 (IQR 1.3–5.1) years. One patient had ureteral reimplantation for symptomatic obstruction 2.8 years after initial surgery. Only 3/99 (3.0%) required open or laparoscopic surgery after Dx/HA injection. Eighty-three families (84.7%) reported ≥1 fUTIs pre-operatively. Of these, only 9/83 (10.8%) reported fUTIs post-operatively, for an overall clinical success rate of 89.2%. Clinical success was 93.1% in patients whose pre-operative fUTIs were treated outpatient and 80.0% in those hospitalized at least once for fUTI treatment pre-operatively. Ninety-four percent of parents were highly satisfied, 2.4% partially satisfied, and 3.5% dissatisfied.Conclusions: Endoscopic injection with Dx/HA for primary VUR appears to have good long-term clinical success rates and high parental satisfaction, mirroring our previously reported short-term results. Post-operative ureteral obstruction is rare but may occur years post-operatively, justifying initial sonographic surveillance, and repeat imaging in symptomatic patients.

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Section: Discussionmentioning

confidence: 99%

Long-Term Clinical Outcomes and Parental Satisfaction After Dextranomer/Hyaluronic Acid (Dx/HA) Injection for Primary Vesicoureteral Reflux

et al. 2019

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“…Peri-urethral bulking agents are substances that are injected peri-urethrally to increase tissue bulk as a treatment of stress incontinence [20] (Figure 4). Patients receive one or several treatment sessions.…”

Section: Urinary Bulking Agents (Ubas)mentioning

confidence: 99%

“…Deflux ® : Q-Med (now Galderma) has been collecting data in Europe for a dextranomer/hyaluronic acid copolymer (Zuidex ® ) together with an injection system (Implacer ® ) for treatment of incontinence. A Dx/HA formulation (Deflux) from the same company has been commercially available for a number of years for the treatment of vesicoureteral reflux in children and has been tried as UBA as well [20].…”

Section: Gr Up Smmentioning

confidence: 99%

Injectable Bulking Agents for the Treatment of Stress Urinary Incontinence

Lemperle¹,

Lemperle²

2017

SM Gerontol Geriatr Res

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Urethral Bulking Agents (UBAs) are injected locally as a minimally invasive procedure for Stress Urinary Incontinence (SUI) and are beneficial for properly selected patients. Many different materials have been developed and are available, although none so far meet all the requirements of an ideal agent. The first UBA was cross-linked bovine collagen (Contigen ® ), followed by autologous fat injections, solid silicone particles (Macroplastique ® ), microspheres covered with pyrolytic carbon (Durasphere ® ), calcium hydroxyapatite (Coaptite ® ), polyacrylamide hydrogel (Bulkamid ® ), and dextran/HA copolymer (Zuidex ® ). The latest product development is PDMS-U, a silicone gel bulking agent that polymerizes in situ (Urolastic ® ).The ideal urinary bulking agent could consist of permanent microspheres, which immediately elicit a modest foreign body reaction along with the production of fibro-vascular tissue, which encapsulate every single microsphere individually and prevent their migration from the injection site. Polymethylmethacrylate microspheres have a successful history as dermal fillers used world-wide and can be safely injected submucosally at the urinary sphincter under direct vision, rather than peri-urethrally into the muscle like most of the present agents.Overall, short-term clinical results with most of the currently used urinary bulking agents are encouraging; however, longer follow-up results are often disappointing and retreatment is required. Proper patient selection and a safe, biocompatible and non-migrating bulking agent that elicits permanent fibro-vascular tissue formation at the injection site are paramount to successful treatment of stress urinary incontinence.

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“…Vesicoureteral re ux (VUR) represents the most common pediatric anomaly of the urinary tract, with increased risk of pyelonephritis and subsequent renal scarring. [1] [2] It affects about 1-3% of all children. [3,4] It can be managed using the widely known, minimally invasive procedure of endoscopic injection of hyaluronic acid/dextranome (De ux).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Bladder Ultrasound in Prediction of Resolution of Vesicoureteral Reflux after Endoscopic Subureteral Hyaluronic Acid/Dextranome (Deflux®) Injection

Aboutaleb¹,

Eldib²,

Omar³

et al. 2021

Preprint

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BACKGROUND: We evaluated the efficacy of bladder ultrasound to predict resolution of vesicoureteral reflux after subureteral endoscopic Hyaluronic acid/dextranome (Deflux) injection.METHODS: Between 2010 and 2018, 120 patients (220 ureters) underwent Subureteral Deflux injection for reflux in children. Male/female ratio was 1: 5. All patients had voiding cystourethrography and bladder ultrasound at 3 months and one year after surgery. Outcome analysis included: Success rates and presence/ absence of Deflux mount by bladder ultrasound. RESULTS: Mean follow-up was 48 months. Mean age at surgery 72 months. Grades of reflux were grade II in 100 ureters (45.4%), III in 90 ureters (41%) and IV-V in 30 ureters (13.6%). Bilateral surgery was performed in 40 patients. Single Deflux injection cured reflux (Success rate) in 85% (187 ureters) at 3 months which improved to 88.2% (194 ureters) at last follow-up. Ultrasound was able to detect Deflux mounts at the base of the bladder in 200 ureters (91%). Sensitivity and specificity of ultrasound was 92.68% and 20% of the correction of reflux at the last follow up. Positive Predictive Value of bladder ultrasound was 94 % and accuracy was 87.7 % at the last follow up. Ultrasound did not detect the mount in 20 ureters (9 %) and 8 of these ureters (3.6%) had persistence of their reflux. Ultrasound was able to detect bilateral mounts as well as unilateral mounts.CONCLUSION: Bladder-US was highly sensitive for detection of Deflux implants and can predict resolution of reflux in 82.7% of refluxing ureters. Postoperative bladder-US could be adjusted as a screening tool in the follow-up of patients with primary low-grade VUR patients treated by Deflux injection, while VCUG could be preserved for follow-up of high-grade VUR patients.

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Endoscopic injection therapy

Cited by 23 publications

References 69 publications

Long-Term Clinical Outcomes and Parental Satisfaction After Dextranomer/Hyaluronic Acid (Dx/HA) Injection for Primary Vesicoureteral Reflux

Long-Term Clinical Outcomes and Parental Satisfaction After Dextranomer/Hyaluronic Acid (Dx/HA) Injection for Primary Vesicoureteral Reflux

Injectable Bulking Agents for the Treatment of Stress Urinary Incontinence

Efficacy of Bladder Ultrasound in Prediction of Resolution of Vesicoureteral Reflux after Endoscopic Subureteral Hyaluronic Acid/Dextranome (Deflux®) Injection

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