Randomized clinical trial comparing endoscopic treatment with dextranomer hyaluronic acid copolymer and Cohen's ureteral reimplantation for vesicoureteral reflux: Long-term results

Abstract Purpose To compare efficacy of Cohen's ureteral reimplantation and endoscopic treatment with Dx/HA in patients with primary VUR grades II, III and IV. Methods From April 2002 to June 2004, patients over 1 year old with VUR grade I, II, III or IV were included. Patients were randomized...

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Bibliographic Details
Published in:Journal of pediatric urology 2013-08, Vol.9 (4), p.483-487
Main Authors: Garcia-Aparicio, L, Rovira, J, Blazquez-Gomez, E, García-García, L, Giménez-Llort, A, Rodo, J, Morales, L
Format: Article
Language:English
Subjects:
Child
Child, Preschool
Dextrans - therapeutic use
Endoscopic treatment
Endoscopy - methods
Female
Follow-Up Studies
Humans
Hyaluronic Acid - therapeutic use
Male
Pediatrics
Replantation - methods
Time Factors
Treatment Outcome
Ureteral Diseases - surgery
Urologic Surgical Procedures - methods
Urology
Vesico-Ureteral Reflux - surgery
Vesicoureteral reflux
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Summary:Abstract Purpose To compare efficacy of Cohen's ureteral reimplantation and endoscopic treatment with Dx/HA in patients with primary VUR grades II, III and IV. Methods From April 2002 to June 2004, patients over 1 year old with VUR grade I, II, III or IV were included. Patients were randomized into two groups: endoscopic treatment (ET) or ureteral reimplantation (UR). In the ET group, an ultrasonography study was performed 24 h and 1 month after surgery, and two voiding cystourethrographies at 3 and 6 months post treatment. In the UR group, an ultrasonography study was done 7 days and 1 month after surgery and a micturial cystography 6 months post surgery. A postoperative nuclear direct cystogram was performed 5 years later in both groups. Results A total of 41 patients were included in this study: in ET 22 patients with 35 refluxing ureters and in UR 19 patients with 32 refluxing ureters. The VUR grades in ET were: 16 grade II, 16 grade III and 3 grade IV; and in UR: 15 grade II, 12 grade III and 5 grade IV. VUR was resolved in 91% (32/35) of ET (28% of ureters needed a second injection), and in 100% of UR group. Five years after the procedure, VUR was still resolved in 30/32 of ET and 32/32 of UR. Conclusion Short- and long-term follow up shows that multiple endoscopic treatment of VUR grades II, III and IV with Dx/HA is as effective as ureteral reimplantation.
ISSN:1477-5131
1873-4898
DOI:10.1016/j.jpurol.2013.03.003