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J Urol. 2008 Oct;180(4 Suppl):1589-92; discussion 1592-3. doi: 10.1016/j.juro.2008.04.073. Epub 2008 Aug 16.

Intra-orifice versus hydrodistention implantation technique in dextranomer/hyaluronic acid injection for vesicoureteral reflux.

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1
Pediatric Urology Section, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas 75390-9142, USA.

Abstract

PURPOSE:

Original implantation procedures used dextranomer/hyaluronic acid to create a volcano-like mound at the orifice. Subsequently the hydrodistention implantation technique was described to coapt the intramural ureteral wall with less emphasis on achieving a mound at the orifice and it was reported to be associated with improved outcomes. We compared the results of intra-orifice injection to establish a mound vs the hydrodistention implantation technique.

MATERIALS AND METHODS:

Univariate and multivariate logistic regression analysis was used to compare results in 96 ureters undergoing intra-orifice injection vs 52 undergoing the hydrodistention implantation technique. We evaluated patient gender and age, reflux grade, injection technique, injected volume and the number of injection sites.

RESULTS:

Successful reflux resolution was achieved in 124 ureters (84%) with a single implantation, including 83 (86.5%) with intra-orifice injection and 41 (79%) with HIT (p = 0.23). Mean injected volume was significantly increased for the hydrodistention implantation technique vs intra-orifice injection (0.68 vs 0.51 cc, p = 0.002). Univariate analysis showed that female gender, older age, reflux grade and number of injection sites were associated with success. On multivariate analysis only reflux grade remained significant.

CONCLUSIONS:

Despite using an increased volume of dextranomer/hyaluronic acid to coapt the intramural ureter and orifice, the hydrodistention implantation technique did not improve results over those of intra-orifice injection with a lesser implant volume.

PMID:
18710753
DOI:
10.1016/j.juro.2008.04.073
[Indexed for MEDLINE]
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