Subureteral Injection with Small-Size Dextranomer/Hyaluronic Acid Copolymer: Is It Really Efficient?

Abstract

The aim of this study was to evaluate the clinical results of patients with vesicoureteral reflux, which were treated with subureteral injection of small-size (80–120 μm) dextranomer/hyaluronic acid copolymer (Dx/HA). Data of 75 children (105 renal units) who underwent STING procedure with small-size Dx/HA for the treatment of vesicoureteral reflux (VUR) in our clinic between 2008 and 2012 were retrospectively analyzed. Preoperative reflux grade and side, injection indication, postoperative urinary infections and urinary symptoms, voiding cystourethrogram, and renal scintigraphy results were evaluated. The success rate of the procedure was 100% in patients with grades 1 and 2 reflux, 91% in patients with grade 3 reflux, and 82.6% in patients with grade 4. Overall success rate of the treated patients was 97%. Endoscopic subureteric injection with Dx/HA procedure has become a reasonable minimally invasive alternative technique to open surgery, long-term antibiotic prophylaxis, and surveillance modalities in treatment of VUR in terms of easy application, low costs and complication rates, and high success rates. Injection material composed of small-size dextranomer microspheres seems superior to normal size Dx/HA, together with offering similar success with low cost.

Examination of Complementary Medicine for Treating Urinary Tract Infections Among Pregnant Women and Children

“…Deflux® is an endoscopically injected drug comprised of dextranomer and hyaluronic acid. The study demonstrated a 100% success rate in patients with grade I and II VUR, 91% in patients with grade III, and 82.6% in patients with grade IV ( Ure et al, 2016 ). A retrospective study conducted earlier investigated the effectiveness of Deflux® for the prevention of UTIs in children with VUR ( Traxel et al, 2009 ).…”

Comment on “Subureteral Injection with Small-Size Dextranomer/Hyaluronic Acid Copolymer: Is It Really Efficient?”

“…We believe that it could be interesting to also study the histological changes in ureteral endings after small-size dextranomer/hyaluronic acid copolymer injection, to verify if this substance has a similar effect of refluxing ureteral tissue. Finally, in our opinion, the data of Üre et al [ 1 ] are very interesting and we would like to congratulate the authors on their splendid paper.…”

“…We read with great interest and appreciated very much the article written by Üre et al [ 1 ]. In their study, the authors evaluated the efficiency of subureteral small-size (80-120 μ m) dextranomer/hyaluronic acid copolymer injection treatment in children affected by 1 to 4 grade vesicoureteral reflux, finding an overall success rate of 97% of the treated patients.…”

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

“…Intra-operative costs were highest with endoscopic injection, but the total cost (intra-operative plus post-operative hospitalization costs) was highest with the Cohen procedure (€8201), and similar with endoscopic treatment and laparoscopic reimplantation (€3283 and €3211, respectively). Observations regarding lower product costs with polyacrylamide hydrogel and small-size dextranomer/hyaluronic acid copolymer vs. NASHA/Dx have been made in some publications ( 88 , 123 , 129 ). Simple comparisons of product costs do not provide a complete pharmacoeconomic picture: formal studies that include the total long-term costs of patient management (influenced by long-term safety and efficacy of the treatments concerned) are needed for true pharmacoeconomic comparisons.…”