Influence of Voiding Dysfunction on the Outcome of Endoscopic Treatment for Vesicoureteral Reflux

Abstract

No AccessJournal of UrologyReflux1 Oct 2002Influence of Voiding Dysfunction on the Outcome of Endoscopic Treatment for Vesicoureteral Reflux Nicola Capozza, Alberto Lais, Ennio Matarazzo, Simona Nappo, Mario Patricolo, and Paolo Caione Nicola CapozzaNicola Capozza , Alberto LaisAlberto Lais , Ennio MatarazzoEnnio Matarazzo , Simona NappoSimona Nappo , Mario PatricoloMario Patricolo , and Paolo CaionePaolo Caione View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64391-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Some patients with vesicoureteral reflux also experience voiding dysfunction. Dextranomer/hyaluronic acid copolymer (Deflux, Q-MED AB, Uppsala, Sweden) is an effective endoscopic treatment for vesicoureteral reflux. In an open label study we investigated the effect of voiding dysfunction on the efficacy of endoscopic treatment with dextranomer/hyaluronic acid copolymer in patients with vesicoureteral reflux. Materials and Methods: A total of 320 children 3 to 11 years old with grade II to IV vesicoureteral reflux confirmed by voiding cystourethrography underwent endoscopic treatment with dextranomer/hyaluronic acid copolymer. Of the patients 50 were re-treated with dextranomer/hyaluronic acid copolymer because of persistent reflux (grade II or greater). The first implantation technique was recorded on videotape. Voiding cystourethrography and micturition details were recorded at the 3 to 6-month followup visit and compared with baseline measurements. Results: At baseline 13 patients had known voiding dysfunction and 18 were misdiagnosed as not having voiding dysfunction. Of the 50 patients who required re-treatment, the initial implant was correctly positioned in 45 according to the videotape. Endoscopic observation at the time of re-treatment revealed no evidence of the implant in 15 patients. The implant was displaced in 27 patients and remained correctly positioned in 3. A total of 27 patients had voiding dysfunction, the majority of whom had urgency and frequency incontinence, had not received any anticholinergic therapy and had a displaced implant. Conclusions: Uncontrolled voiding dysfunction contributed to endoscopic treatment failure with dextranomer/hyaluronic acid copolymer in our series. Therefore, we suggest that patients with voiding dysfunction be treated at least 6 months before endoscopic therapy with anticholinergics and/or micturition rehabilitation. References 1 : Vesico-ureteric reflux: occurrence and long-term risks. Acta Paediatr, suppl1999; 88: 22. Google Scholar 2 : Changing concepts concerning the management of vesicoureteral reflux. J Urol2001; 166: 1439. Link, Google Scholar 3 : Bladder dysfunction in children with vesico-ureteric reflux. Acta Paediatr, suppl1999; 88: 40. Google Scholar 4 : Pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children. J Urol1997; 157: 1846. Link, Google Scholar 5 : Dextranomer/hyaluronic acid copolymer implantation for vesico-ureteral reflux: a randomized comparison with antibiotic prophylaxis. J Pediatr2002; 140: 230. Google Scholar 6 : Endoscopic treatment of children with vesico-ureteric reflux. Acta Paediatr, suppl1999; 88: 62. Google Scholar 7 : Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol2001; 166: 1887. Link, Google Scholar 8 : Endoscopic treatment of vesico-ureteral reflux: twelve years' experience. Urol Int2001; 67: 228. Google Scholar 9 : A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results. J Urol1995; 154: 800. Link, Google Scholar 10 : Vesicoureteral reflux in infants. Pediatr Nephrol1999; 13: 355. Google Scholar 11 : Relationship among pediatric voiding dysfunction and vesicoureteral reflux and renal scars. Urology1999; 54: 905. Google Scholar 12 : Urodynamic dysfunction in infants with vesicoureteral reflux. J Pediatr2000; 136: 754. Google Scholar 13 : The impact of treated dysfunctional voiding on the nonsurgical management of vesicoureteral reflux. J Urol1998; 160: 1823. Link, Google Scholar 14 : Guidelines for consideration for surgical repair of vesicoureteral reflux. Curr Opin Urol2000; 10: 579. Google Scholar 15 : New renal scars in children with urinary tract infections, vesicoureteral reflux and voiding dysfunction: a prospective evaluation. J Urol1997; 158: 566. Link, Google Scholar 16 : The relationship between dysfunction voiding and congenital vesicoureteral reflux. Curr Opin Urol2000; 10: 607. Google Scholar 17 : Lack of distant migration after injection of a 125iodine labeled dextranomer based implant into the rabbit bladder. J Urol1997; 158: 1937. Link, Google Scholar 18 : Chronic tissue response to implantation of Debrisan; an experimental study. Clin Ther1977; 1: 151. Google Scholar 19 : Injectable dextranomer-based implant: histopathology, volume changes and DNA analysis. Scand J Urol Nephrol1999; 33: 355. Google Scholar From the Department of Pediatric Urology, Ospedale Bambino Gesú, Rome, Italy© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByHidas G, Soltani T, Watts B, Pribish M and Khoury A (2018) Is the Appearance of the Dextranomer/Hyaluronic Acid Mound Predictive of Reflux Resolution?Journal of Urology, VOL. 189, NO. 5, (1882-1885), Online publication date: 1-May-2013.Fast A, Nees S, Van Batavia J, Combs A and Glassberg K (2018) Outcomes of Targeted Treatment for Vesicoureteral Reflux in Children with Nonneurogenic Lower Urinary Tract DysfunctionJournal of Urology, VOL. 190, NO. 3, (1028-1033), Online publication date: 1-Sep-2013.Puri P, Kutasy B, Colhoun E and Hunziker M (2012) Single Center Experience with Endoscopic Subureteral Dextranomer/Hyaluronic Acid Injection as First Line Treatment in 1,551 Children with Intermediate and High Grade Vesicoureteral RefluxJournal of Urology, VOL. 188, NO. 4S, (1485-1489), Online publication date: 1-Oct-2012.Ben-Meir D, Morgenstern S, Sivan B, Efrat R and Livne P (2018) Histology Proved Malpositioning of Dextranomer/Hyaluronic Acid in Submucosal Ureter in Patients After Failed Endoscopic Treatment of Vesicoureteral RefluxJournal of Urology, VOL. 188, NO. 1, (258-261), Online publication date: 1-Jul-2012.Ormaechea M, Ruiz E, Denes E, Gimenez F, Dénes F, Moldes J, Amarante A, Pioner G, Dekermacher S and de Badiola F (2018) New Tissue Bulking Agent (Polyacrylate Polyalcohol) for Treating Vesicoureteral Reflux: Preliminary Results in ChildrenJournal of Urology, VOL. 183, NO. 2, (714-718), Online publication date: 1-Feb-2010.Dave S, Lorenzo A, Khoury A, Braga L, Skeldon S, Suoub M, Farhat W, Pippi Salle J and Bägli D (2008) Learning From the Learning Curve: Factors Associated With Successful Endoscopic Correction of Vesicoureteral Reflux Using Dextranomer/Hyaluronic Acid CopolymerJournal of Urology, VOL. 180, NO. 4S, (1594-1600), Online publication date: 1-Oct-2008.Sedberry-Ross S, Rice D, Pohl H, Belman A, Majd M and Rushton H (2008) Febrile Urinary Tract Infections in Children With an Early Negative Voiding Cystourethrogram After Treatment of Vesicoureteral Reflux With Dextranomer/Hyaluronic AcidJournal of Urology, VOL. 180, NO. 4S, (1605-1610), Online publication date: 1-Oct-2008.Jung C, DeMarco R, Lowrance W, Pope J, Adams M, Dietrich M and Brock J (2018) Subureteral Injection of Dextranomer/Hyaluronic Acid Copolymer for Persistent Vesicoureteral Reflux Following UreteroneocystostomyJournal of Urology, VOL. 177, NO. 1, (312-315), Online publication date: 1-Jan-2007.Higham-Kessler J, Reinert S, Snodgrass W, Hensle T, Koyle M, Hurwitz R, Cendron M, Diamond D and Caldamone A (2018) A Review of Failures of Endoscopic Treatment of Vesicoureteral Reflux With Dextranomer MicrospheresJournal of Urology, VOL. 177, NO. 2, (710-715), Online publication date: 1-Feb-2007.Läckgren G, Sköldenberg E and Stenberg A (2018) Endoscopic Treatment With Stabilized Nonanimal Hyaluronic Acid/Dextranomer Gel is Effective in Vesicoureteral Reflux Associated With Bladder DysfunctionJournal of Urology, VOL. 177, NO. 3, (1124-1129), Online publication date: 1-Mar-2007.Mevorach R, Hulbert W, Rabinowitz R, Kennedy W, Kogan B, Kryger J, Caldamone A, Clark W, Kaplan G, Durkee C and Elder J (2018) Results of a 2-Year Multicenter Trial of Endoscopic Treatment of Vesicoureteral Reflux With Synthetic Calcium HydroxyapatiteJournal of Urology, VOL. 175, NO. 1, (288-291), Online publication date: 1-Jan-2006.Routh J, Vandersteen D, Pfefferle H, Wolpert J and Reinberg Y (2018) Single Center Experience With Endoscopic Management of Vesicoureteral Reflux in ChildrenJournal of Urology, VOL. 175, NO. 5, (1889-1893), Online publication date: 1-May-2006.CAPOZZA N, LAIS A, NAPPO S and CAIONE P (2018) THE ROLE OF ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX: A 17-YEAR EXPERIENCEJournal of Urology, VOL. 172, NO. 4 Part 2, (1626-1629), Online publication date: 1-Oct-2004.PEREZ-BRAYFIELD M, KIRSCH A, HENSLE T, KOYLE M, FURNESS P and SCHERZ H (2018) ENDOSCOPIC TREATMENT WITH DEXTRANOMER/HYALURONIC ACID FOR COMPLEX CASES OF VESICOURETERAL REFLUXJournal of Urology, VOL. 172, NO. 4 Part 2, (1614-1616), Online publication date: 1-Oct-2004.DIAMOND D, CALDAMONE A, BAUER S and RETIK A (2018) Mechanisms of Failure of Endoscopic Treatment of Vesicoureteral Reflux Based on Endoscopic AnatomyJournal of Urology, VOL. 170, NO. 4 Part 2, (1556-1559), Online publication date: 1-Oct-2003. Volume 168Issue 4 Part 2October 2002Page: 1695-1698 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsdextransvesico-ureteral refluxchildhyaluronic acidurinary incontinenceMetricsAuthor Information Nicola Capozza More articles by this author Alberto Lais More articles by this author Ennio Matarazzo More articles by this author Simona Nappo More articles by this author Mario Patricolo More articles by this author Paolo Caione More articles by this author Expand All Advertisement PDF DownloadLoading ...