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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00392

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

Michelle Lightfoot1,  Aylin N. Bilgutay1*, Noah Tollin2,  Scott Eisenberg2, Jake Weiser2, Leah Bryan3,  Edwin Smith1, James Elmore1, Hal Scherz1 and  Andrew J. Kirsch1
  • 1Children's Healthcare of Atlanta, United States
  • 2University of Georgia, United States
  • 3Emory University, United States

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 preoperatively and postoperatively. Patient demographics, radiographic VUR data, need for secondary surgery, and surgical indications were obtained through chart review.

Results: 575 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 postoperatively. 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 preoperatively. Of these, only 9/83 (10.8%) reported fUTIs postoperatively, for an overall clinical success rate of 89.2%. Clinical success was 93.1% in patients whose preoperative fUTIs were treated outpatient and 80.0% in those hospitalized at least once for fUTI treatment preoperatively. 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. Postoperative ureteral obstruction is rare but may occur years postoperatively, justifying initial sonographic surveillance and repeat imaging in symptomatic patients.

Keywords: vesicoureteral reflux, Urinary tract infection, Endoscopic Surgery, long-term effect, Patient Outcome Assessment

Received: 21 May 2019; Accepted: 12 Sep 2019.

Copyright: © 2019 Lightfoot, Bilgutay, Tollin, Eisenberg, Weiser, Bryan, Smith, Elmore, Scherz and Kirsch. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Aylin N. Bilgutay, Children's Healthcare of Atlanta, Atlanta, Georgia, United States,