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J Urol. 2014 Dec;192(6):1794-9. doi: 10.1016/j.juro.2014.05.116. Epub 2014 Jun 10.

Prospective study of polydimethylsiloxane vs dextranomer/hyaluronic acid injection for treatment of vesicoureteral reflux.

Author information

1
Division of Urology, Department of Surgery, CHU de Québec, Université Laval, Quebec City, Quebec, Canada. Electronic address: katherine.moore.1@ulaval.ca.
2
Division of Urology, Department of Surgery, CHU de Québec, Université Laval, Quebec City, Quebec, Canada.

Abstract

PURPOSE:

Endoscopic injection of a bulking agent is becoming a first-line treatment for low grade vesicoureteral reflux. We prospectively compared the efficacy of 2 such products commercially available in Canada.

MATERIALS AND METHODS:

A total of 275 patients with documented grade I to V vesicoureteral reflux were prospectively enrolled in a comparative study between April 2005 and February 2011 to be randomly treated endoscopically with either polydimethylsiloxane (Macroplastique®) or dextranomer/hyaluronic acid copolymer (Deflux®). Of the ureters 202 were treated with polydimethylsiloxane and 197 with dextranomer/hyaluronic acid copolymer. Patients were followed with voiding cystourethrography at 3 months and renal ultrasonography at 3 months and at 1 year. Median followup was 4.3 years. The primary outcome was surgical success (resolution vs nonresolution), and secondary outcomes included occurrence of adverse events.

RESULTS:

Vesicoureteral reflux was fully corrected in 182 of 202 ureters (90%) treated with polydimethylsiloxane, compared to 159 of 197 (81%) treated with dextranomer/hyaluronic acid copolymer (p <0.05). Obstruction was found in 5 ureters. Univariate and multivariate analyses did not allow identification of any characteristics that could explain the significant difference in the success rates except for the type of product used.

CONCLUSIONS:

We present the largest known prospective evaluation comparing 2 bulking agents for the treatment of vesicoureteral reflux. Endoscopic injection of polydimethylsiloxane resulted in a better success rate than dextranomer/hyaluronic acid copolymer. The rate of resolution obtained with the latter is lower than those previously published due to the inclusion of high grade reflux.

KEYWORDS:

endoscopy; hyaluronic acid; injections; urinary tract infections; vesico-ureteral reflux

Comment in

PMID:
24928269
DOI:
10.1016/j.juro.2014.05.116
[Indexed for MEDLINE]

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