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Proprietary non-animal stabilized hyaluronic acid/dextranomer gel (NASHA/Dx) for endoscopic treatment of grade IV vesicoureteral reflux : Longterm observational study
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- Stenbäck, Anders (author)
- Uppsala universitet,Institutionen för kvinnors och barns hälsa,Univ Childrens Hosp, Urol Sect, S-75185 Uppsala, Sweden.
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- Olafsdottir, Thora (author)
- Uppsala universitet,Institutionen för kvinnors och barns hälsa,Univ Childrens Hosp, Urol Sect, S-75185 Uppsala, Sweden.
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- Sköldenberg, Erik, 1967- (author)
- Uppsala universitet,Institutionen för kvinnors och barns hälsa,Univ Childrens Hosp, Urol Sect, S-75185 Uppsala, Sweden.
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- ELSEVIER SCI LTD, 2020
- 2020
- English.
- In: Journal of Pediatric Urology. - : ELSEVIER SCI LTD. - 1477-5131 .- 1873-4898. ; 16:3
- Journal article (peer-reviewed)
Abstract
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- Background Since 1993, children aged >1 year with persistent grade III-V vesicoureteral reflux (VUR) and febrile urinary tract infections (UTIs) attending Uppsala University Hospital have undergone endoscopic injection with proprietary non-animal stabilized hyaluronic acid/dextranomer gel (NASHA/Dx; Deflux (R)). Objective Investigate long-term incidence of UTI, bladder dysfunction, ureteral reimplantation and overall clinical findings following endoscopic injection of NASHA/Dx. Study design Children with grade IV VUR diagnosed by voiding cystourethrogram (VCUG) and dilating VUR persisting for >1 year were included in this study. 15-25 years after endoscopic treatment, patients' hospital charts were studied. Information on bladder function and UTIs was obtained via questionnaire, 8-18 years after endoscopic treatment. Results 185 patients (69 boys, 116 girls) were included in the study; 237 grade IV VUR ureters were treated. All study patients were diagnosed with VUR after a febrile UTI (i.e. pyelonephritis). According to the last voiding cystourethrogram, 69% of ureters showed a positive response (VUR grade 0-I), 7% had VUR grade II and 23% had VUR grade >= III. 46 patients (25%) required ureteral reimplantation during follow-up. Among patients treated during the second 5-year period compared with the first (1998-2003 versus 1993-1998), there was a significant decrease in the rate of ureteral reimplantation (31% vs 16%; p = 0.0365). This difference may be attributable to developments over time in the injection technique. UTIs occurred in 30 patients (21% of the evaluable population): 28 females and 2 males. Febrile UTIs were reported in 14 patients (10%), all females. Forty-nine patients (34%) had bladder problems (e.g. underactivity, overactivity, incontinence). Five patients underwent ureteral reimplantation 'late', 6-10 years after the last endoscopic injection. In one male patient, calcification around the NASHA/Dx implantation site was observed during routine examination 2 years after endoscopic treatment; no intervention was required. No safety issues were observed in the remaining 97% of the study population. Conclusions This study represents the longest published followu-p of Grade IV VUR patients undergoing endoscopic treatment. Three-quarters of patients did not need ureteral reimplantation. Optimal injection technique and higher injection volume were associated with a reduced ureteral reimplantation rate. Treatment with NASHA/Dx was durable and well tolerated: long-term risks of UTI, bladder dysfunction and recurrent VUR were low. [GRAPHICS] .
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
Keyword
- Vesicoureteral reflux
- Children
- Deflux
- NASHA/Dx
- Urinary tract infection
Publication and Content Type
- ref (subject category)
- art (subject category)
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