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Warren T Snodgrass - One of the best experts on this subject based on the ideXlab platform.
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intra orifice versus hydrodistention implantation technique in Dextranomer hyaluronic acid injection for vesicoureteral reflux
The Journal of Urology, 2008Co-Authors: Amit Gupta, Warren T SnodgrassAbstract: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 signifi...
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urinary tract infection following successful Dextranomer hyaluronic acid injection for vesicoureteral reflux
The Journal of Urology, 2008Co-Authors: Andrew Chi, Amit Gupta, Warren T SnodgrassAbstract:Purpose: The incidence of symptomatic urinary tract infection following reflux resolution by endoscopic injection is unclear. We determined the occurrence of febrile and nonfebrile urinary tract infections, and factors relating to development of infection after reflux correction with Dextranomer/hyaluronic acid injection.Materials and Methods: We identified 175 patients with more than 6 months of followup after successful Dextranomer/hyaluronic acid injection by one of us (WS) to resolve vesicoureteral reflux. Of these patients data regarding post-injection symptomatic urinary tract infection could be obtained from parents and/or primary care physicians and urological records in 167, who comprised the study group. All patient reported infections were additionally verified by review of medical records. Univariate and multivariate logistic regression analyses were done, evaluating factors including gender, age, voiding dysfunction, reflux grade, unilateral vs bilateral reflux, number of pretreatment infecti...
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multivariate analysis of factors predicting success with Dextranomer hyaluronic acid injection for vesicoureteral reflux
The Journal of Urology, 2007Co-Authors: Selcuk Yucel, Amit Gupta, Warren T SnodgrassAbstract:Purpose: Factors influencing outcomes of Dextranomer/hyaluronic acid injection for vesicoureteral reflux remain poorly defined. We performed multivariate analysis of the experience of 1 surgeon (WS).Materials and Methods: The study group contained 168 patients and 259 refluxing units. Goal of injection was coaptation of the orifice with creation of a volcanic mound. Outcomes were determined by cystography obtained 12 weeks following injection. Intraoperative photographs of mounds were independently reviewed by 2 authors (WS, SY) without knowledge of results, and classified as “satisfactory” or “other.” Univariate and multivariate logistic regression analysis was done evaluating influence of gender, age, voiding dysfunction, reflux grade, unilateral vs bilateral reflux, ureteral duplication, orifice laterality, subureteral vs intraureteral injection, volume injected and mound appearance.Results: A single injection resolved reflux in 70% of patients and 78% of ureters. Additional injection resulted in overa...
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A Review of Failures of Endoscopic Treatment of Vesicoureteral Reflux With Dextranomer Microspheres
Journal of Urology, 2007Co-Authors: James Higham-kessler, Martin A. Koyle, Warren T Snodgrass, Terry W Hensle, Steven E. Reinert, Richard S. Hurwitz, Marc Cendron, David A. Diamond, Anthony A. CaldamoneAbstract:Purpose: We evaluated the appearance of the mound of failed endoscopic Dextranomer microsphere injections at the time of reinjection or open ureteral reimplantation.Materials and Methods: We performed a multi-institutional study of 80 patients (97 ureters) who were diagnosed with vesicoureteral reflux and had failed endoscopic treatment with Dextranomer microspheres. Observations of injected mound characteristics were made during the time of reinjection or at open ureteral reimplantation. Correlations were made with the pre-injection grade of reflux, volume of initial injection, number of punctures used for the initial injection and presence of symptoms of dysfunctional voiding.Results: Examination of the failed injection sites before subsequent injections or open surgery revealed mound abnormalities in all but 13 of the 97 ureters. Of the cases 49% demonstrated a shifted mound, 22% an absent mound and 10% a loss of volume in the mound. Of the 13 patients with normal appearing mounds 7 had improved reflux...
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obstruction of a dysmorphic ureter following Dextranomer hyaluronic acid copolymer
The Journal of Urology, 2004Co-Authors: Warren T SnodgrassAbstract:Ureteral obstruction is a rare complication of endoscopic therapy for vesicoureteral reflux, reported in less than 1% of patients treated with polytetrafluoroethylene paste and in no case to date following Dextranomer/hyaluronic acid copolymer injection. We report a case of persistent obstruction of an apparently dysmorphic ureter after Dextranomer/hyaluronic acid injection.
Andrew J. Kirsch - One of the best experts on this subject based on the ideXlab platform.
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Dextranomer-hyaluronic acid implants misdiagnosed as bladder tumor on transvaginal ultrasonography.
Obstetrics & Gynecology, 2012Co-Authors: John J. Decaro, Andrew J. KirschAbstract:BACKGROUND: The endoscopic injection of Dextranomer-hyaluronic acid has become a popular treatment for childhood vesicoureteral reflux. Treated children are predominantly girls, and many are now entering adulthood. It has been reported in children that the radiographic appearance of implants may lead to misdiagnoses and unnecessary, invasive diagnostic procedures. CASE: We report the case of a woman treated with Dextranomer-hyaluronic acid for childhood vesicoureteral reflux misdiagnosed with a bladder tumor on transvaginal ultrasonography. Renal ultrasound examination and urinalysis results were normal. Invasive testing was avoided given the history and characteristic ultrasonographic appearance of retained implants. CONCLUSION: It is important for health care providers to be aware of the radiographic appearance of Dextranomer-hyaluronic acid implants in adults and to elicit an appropriate past medical history to avoid misdiagnosis and invasive diagnostic procedures.
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appearance of Dextranomer hyaluronic acid copolymer implants on computerized tomography after endoscopic treatment of vesicoureteral reflux in children
The Journal of Urology, 2009Co-Authors: Wolfgang H. Cerwinka, Hal C. Scherz, Jing Qian, Kirk A. Easley, Andrew J. KirschAbstract:Purpose: With the increasing popularity of endoscopic treatment for vesicoureteral reflux in children, Dextranomer/hyaluronic acid copolymer implants are more frequently detected on computerized tomography, which may lead to misinterpretation and unnecessary intervention. The objective of this study was to characterize the long-term appearance of Dextranomer/hyaluronic acid copolymer implants on computerized tomography.Materials and Methods: We evaluated the hospital charts of 893 patients who had undergone Dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux between July 2001 and November 2007 to identify those who underwent subsequent computerized tomography of the abdomen and pelvis. A total of 30 patients with ureterovesical junction stones served as the control group. Seven patients who proceeded to extravesical reimplantation after failed endoscopic treatment had Dextranomer/hyaluronic acid copolymer implants explanted and microscopically evaluated.Results: Of 893 patients who h...
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incidence of urinary tract infections in children after successful ureteral reimplantation versus endoscopic Dextranomer hyaluronic acid implantation
The Journal of Urology, 2008Co-Authors: James M. Elmore, Andrew J. Kirsch, Erik A. Heiss, Alienor Gilchrist, Hal C. ScherzAbstract:Purpose: Endoscopic implantation of Dextranomer/hyaluronic acid has proved to be an effective minimally invasive technique for correcting vesicoureteral reflux in children. There is some evidence suggesting that in addition to being less invasive, successful Dextranomer/hyaluronic acid implantation compared to successful antireflux surgery is associated with fewer febrile and nonfebrile urinary tract infections. We review the clinical outcomes of 2 groups of children cured of reflux with open surgery and Dextranomer/hyaluronic acid implantation to determine if a difference in clinical outcomes exists.Materials and Methods: We reviewed the charts of 43 patients who underwent Dextranomer/hyaluronic acid implantation and 33 who underwent open surgery for vesicoureteral reflux. Data collected included age, gender, preoperative and postoperative grades of reflux, and urinalysis and urine culture results. Urinary tract infection was defined as any culture that grew more than 105 colonies of a single organism, w...
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endoscopic treatment of vesicoureteral reflux using Dextranomer hyaluronic acid copolymer
Journal of Pediatric Urology, 2008Co-Authors: Joseph A Molitierno, Hal C. Scherz, Andrew J. KirschAbstract:Vesicoureteral reflux (VUR) is a common urinary tract anomaly. Treatment is performed to minimize the risk of febrile urinary UTIs that may result in renal scarring. The endoscopic use of Dextranomer hyaluronic acid copolymer has been gaining popularity as an alternative to the traditional methods of open surgery and chronic antibiotic prophylaxis. The aim of this educational review was to present the trends, latest perspectives and surgical techniques regarding this newer method of treatment of VUR. Evolving techniques are described that have resulted in VUR cure rates that rival that of open ureteral reimplantation with minimal associated morbidity. These have proven to be effective in complex cases that were previously considered as contraindications for endoscopic treatment, including voiding dysfunction, duplex ureters, high-grade VUR and paraureteral diverticuli. It is recommended that open reimplantation be reserved for those children with ectopic ureters, megaureters that require tapering or secondary grade V VUR, and those who have failed two endoscopic injections. Future advances promise to standardize the injection technique, ensuring optimum needle placement for consistently successful injections.
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long term preservation of Dextranomer hyaluronic acid copolymer implants after endoscopic treatment of vesicoureteral reflux in children a sonographic volumetric analysis
The Journal of Urology, 2007Co-Authors: Leah P. Mcmann, Hal C. Scherz, Andrew J. KirschAbstract:Purpose: We compared injected volume of Dextranomer/hyaluronic acid with sonographic volumes obtained 2 weeks to 36 months postoperatively to evaluate the amount of volume retention with time and to correlate volume retention with voiding cystourethrogram results.Materials and Methods: We retrospectively reviewed sonographic volume measurements of Dextranomer/hyaluronic acid implants in children at 2 weeks to 36 months postoperatively. Hydronephrosis and percentage of Dextranomer/hyaluronic acid retained at each interval were recorded. Average change in volume at each interval was used to compare volume retention with time. The fraction of Dextranomer/hyaluronic acid retained was compared to voiding cystourethrogram at 3 months.Results: No patient had new or worsened hydronephrosis. Volumetric data were available for 296, 150, 42, 23 and 20 ureters at 2, 3, 6 and 12 weeks, and 24 to 36 months postoperatively, respectively. Percentage of Dextranomer/hyaluronic acid retained was 79% at 2, 74% at 3, 70% at 6...
Hal C. Scherz - One of the best experts on this subject based on the ideXlab platform.
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appearance of Dextranomer hyaluronic acid copolymer implants on computerized tomography after endoscopic treatment of vesicoureteral reflux in children
The Journal of Urology, 2009Co-Authors: Wolfgang H. Cerwinka, Hal C. Scherz, Jing Qian, Kirk A. Easley, Andrew J. KirschAbstract:Purpose: With the increasing popularity of endoscopic treatment for vesicoureteral reflux in children, Dextranomer/hyaluronic acid copolymer implants are more frequently detected on computerized tomography, which may lead to misinterpretation and unnecessary intervention. The objective of this study was to characterize the long-term appearance of Dextranomer/hyaluronic acid copolymer implants on computerized tomography.Materials and Methods: We evaluated the hospital charts of 893 patients who had undergone Dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux between July 2001 and November 2007 to identify those who underwent subsequent computerized tomography of the abdomen and pelvis. A total of 30 patients with ureterovesical junction stones served as the control group. Seven patients who proceeded to extravesical reimplantation after failed endoscopic treatment had Dextranomer/hyaluronic acid copolymer implants explanted and microscopically evaluated.Results: Of 893 patients who h...
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incidence of urinary tract infections in children after successful ureteral reimplantation versus endoscopic Dextranomer hyaluronic acid implantation
The Journal of Urology, 2008Co-Authors: James M. Elmore, Andrew J. Kirsch, Erik A. Heiss, Alienor Gilchrist, Hal C. ScherzAbstract:Purpose: Endoscopic implantation of Dextranomer/hyaluronic acid has proved to be an effective minimally invasive technique for correcting vesicoureteral reflux in children. There is some evidence suggesting that in addition to being less invasive, successful Dextranomer/hyaluronic acid implantation compared to successful antireflux surgery is associated with fewer febrile and nonfebrile urinary tract infections. We review the clinical outcomes of 2 groups of children cured of reflux with open surgery and Dextranomer/hyaluronic acid implantation to determine if a difference in clinical outcomes exists.Materials and Methods: We reviewed the charts of 43 patients who underwent Dextranomer/hyaluronic acid implantation and 33 who underwent open surgery for vesicoureteral reflux. Data collected included age, gender, preoperative and postoperative grades of reflux, and urinalysis and urine culture results. Urinary tract infection was defined as any culture that grew more than 105 colonies of a single organism, w...
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endoscopic treatment of vesicoureteral reflux using Dextranomer hyaluronic acid copolymer
Journal of Pediatric Urology, 2008Co-Authors: Joseph A Molitierno, Hal C. Scherz, Andrew J. KirschAbstract:Vesicoureteral reflux (VUR) is a common urinary tract anomaly. Treatment is performed to minimize the risk of febrile urinary UTIs that may result in renal scarring. The endoscopic use of Dextranomer hyaluronic acid copolymer has been gaining popularity as an alternative to the traditional methods of open surgery and chronic antibiotic prophylaxis. The aim of this educational review was to present the trends, latest perspectives and surgical techniques regarding this newer method of treatment of VUR. Evolving techniques are described that have resulted in VUR cure rates that rival that of open ureteral reimplantation with minimal associated morbidity. These have proven to be effective in complex cases that were previously considered as contraindications for endoscopic treatment, including voiding dysfunction, duplex ureters, high-grade VUR and paraureteral diverticuli. It is recommended that open reimplantation be reserved for those children with ectopic ureters, megaureters that require tapering or secondary grade V VUR, and those who have failed two endoscopic injections. Future advances promise to standardize the injection technique, ensuring optimum needle placement for consistently successful injections.
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long term preservation of Dextranomer hyaluronic acid copolymer implants after endoscopic treatment of vesicoureteral reflux in children a sonographic volumetric analysis
The Journal of Urology, 2007Co-Authors: Leah P. Mcmann, Hal C. Scherz, Andrew J. KirschAbstract:Purpose: We compared injected volume of Dextranomer/hyaluronic acid with sonographic volumes obtained 2 weeks to 36 months postoperatively to evaluate the amount of volume retention with time and to correlate volume retention with voiding cystourethrogram results.Materials and Methods: We retrospectively reviewed sonographic volume measurements of Dextranomer/hyaluronic acid implants in children at 2 weeks to 36 months postoperatively. Hydronephrosis and percentage of Dextranomer/hyaluronic acid retained at each interval were recorded. Average change in volume at each interval was used to compare volume retention with time. The fraction of Dextranomer/hyaluronic acid retained was compared to voiding cystourethrogram at 3 months.Results: No patient had new or worsened hydronephrosis. Volumetric data were available for 296, 150, 42, 23 and 20 ureters at 2, 3, 6 and 12 weeks, and 24 to 36 months postoperatively, respectively. Percentage of Dextranomer/hyaluronic acid retained was 79% at 2, 74% at 3, 70% at 6...
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postoperative ureteral obstruction after subureteral injection of Dextranomer hyaluronic acid copolymer
The Journal of Urology, 2006Co-Authors: David R. Vandersteen, Hal C. Scherz, Andrew J. Kirsch, Jonathan C. Routh, Michael L Ritchey, Ellen Shapiro, James J Wolpert, Heidi Pfefferle, Yuri ReinbergAbstract:Purpose: Subureteral injection of Dextranomer/hyaluronic acid copolymer is widely accepted for the treatment of primary vesicoureteral reflux. Few studies document the incidence of surgically relevant postoperative obstruction or the characteristics of patients at risk.Materials and Methods: Four institutions had reported surgically relevant postoperative obstruction to representatives of Q-Med Scandinavia, the manufacturers of Deflux® (Dextranomer/hyaluronic acid). All children undergoing Dextranomer/hyaluronic acid injection at these institutions were evaluated in this study. Patients requiring postoperative stenting were retrospectively reviewed for pertinent history, volume injected, technique of injection, duration of symptoms before intervention, duration of intervention and final outcome.Results: A total of 745 patients (1,155 ureters) underwent injection. Five patients (6 renal units, 7 ureters) required stenting for obstructive symptoms and hydronephrosis, of whom 4 immediately became symptomatic...
Prem Puri - One of the best experts on this subject based on the ideXlab platform.
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endoscopic injection of Dextranomer hyaluronic acid as first line treatment in 851 consecutive children with high grade vesicoureteral reflux efficacy and long term results
The Journal of Urology, 2018Co-Authors: Florian Friedmacher, Prem Puri, Eric ColhounAbstract:Purpose: Endoscopic injection of Dextranomer/hyaluronic acid is widely acknowledged as first line treatment of lower grade vesicoureteral reflux. We demonstrate its long-term efficacy and safety in eradicating high grade reflux.Materials and Methods: A total of 518 girls and 333 boys with a median age of 2.3 years (range 2 months to 13.7 years) underwent endoscopic correction of high grade vesicoureteral reflux using Dextranomer/hyaluronic acid. Reflux was unilateral in 415 cases and bilateral in 436, comprising 1,287 refluxing units. Reflux was grade IV in 1,153 ureters (89.6%) and grade V in 134 (10.4%). 99mTechnetium-dimercaptosuccinic acid scintigraphy identified renal scarring in 317 patients (37.3%). Followup ultrasound and voiding cystourethrogram were performed 3 months after intervention and renal ultrasound yearly thereafter. Median followup was 8.5 years (range 6 months to 16 years).Results: Overall resolution rate after the first endoscopic injection was 69.5% (895 of 1,287 cases), with resolu...
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Dextranomer hyaluronic acid endoscopic injection is effective in the treatment of intermediate and high grade vesicoureteral reflux in patients with complete duplex systems
The Journal of Urology, 2013Co-Authors: Manuela Hunziker, Nochiparambil Mohanan, Prem PuriAbstract:Purpose: Endoscopic subureteral injection of Dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis or surgical treatment for vesicoureteral reflux. We evaluated the effectiveness of endoscopic injection of Dextranomer/hyaluronic acid in intermediate and high grade vesicoureteral reflux in patients with complete duplex collecting systems.Materials and Methods: A total of 123 children underwent endoscopic correction of intermediate or high grade vesicoureteral reflux using injection of Dextranomer/hyaluronic acid into complete duplex systems between 2001 and 2010. Vesicoureteral reflux was diagnosed by voiding cystourethrogram, and dimercapto-succinic acid scan was performed to evaluate the presence of renal scarring. Followup ultrasound and voiding cystourethrogram were performed 3 months after the outpatient procedure and renal ultrasound thereafter every 2 years. Mean followup was 6.7 years.Results: Complete duplex systems were unilateral in 110 patients an...
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single center experience with endoscopic subureteral Dextranomer hyaluronic acid injection as first line treatment in 1 551 children with intermediate and high grade vesicoureteral reflux
The Journal of Urology, 2012Co-Authors: Prem Puri, Eric Colhoun, Balazs Kutasy, Manuela HunzikerAbstract:Purpose: In recent years the endoscopic injection of Dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis and the surgical management of vesicoureteral reflux. We determined the safety and effectiveness of the endoscopic injection of Dextranomer/hyaluronic acid as first line treatment for high grade vesicoureteral reflux.Materials and Methods: Between 2001 and 2010, 1,551 children (496 male, 1,055 female, median age 1.6 years) underwent endoscopic correction of intermediate and high grade vesicoureteral reflux using Dextranomer/hyaluronic acid soon after the diagnosis of vesicoureteral reflux on initial voiding cystourethrogram. Vesicoureteral reflux was unilateral in 761 children and bilateral in 790. Renal scarring was detected in 369 (26.7%) of the 1,384 patients who underwent dimercapto-succinic acid imaging. Reflux grade in the 2,341 ureters was II in 98 (4.2%), III in 1,340 (57.3%), IV in 818 (34.9%) and V in 85 (3.6%). Followup ultrasound and voiding...
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endoscopic treatment of moderate and high grade vesicoureteral reflux in infants using Dextranomer hyaluronic acid
The Journal of Urology, 2007Co-Authors: Prem Puri, Nochiparambil Mohanan, Maria Menezes, Eric ColhounAbstract:Purpose: Renal parenchymal injury in vesicoureteral reflux occurs early, in most patients before age 3 years. It is generally believed that early prevention of urinary tract infections may decrease the amount of renal parenchymal damage. Endoscopic treatment for vesicoureteral reflux has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. We prospectively evaluated the effectiveness and safety of Dextranomer/hyaluronic acid copolymer for high grade vesicoureteral reflux in infants.Materials and Methods: A total of 276 infants, including 124 boys and 152 girls, with a median age of 7 months (range 2 to 12) underwent endoscopic treatment for vesicoureteral reflux with Dextranomer/hyaluronic acid. Reflux was detected in 225 infants following investigation for urinary tract infection, in 46 following screening for sibling vesicoureteral reflux and in 5 for prenatally diagnosed hydronephrosis. Vesicoureteral reflux was unilateral in 85 infants and bilateral in 191...
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subureteral Dextranomer hyaluronic acid injection as first line treatment in the management of high grade vesicoureteral reflux
The Journal of Urology, 2006Co-Authors: Prem Puri, Nochiparambil Mohanan, Martina A Pirker, Michal Dawrant, Laxman Dass, Eric ColhounAbstract:Purpose: Endoscopic correction of vesicoureteral reflux has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. A number of tissue augmenting substances have been used for the endoscopic correction of vesicoureteral reflux. We prospectively evaluated the effectiveness of Dextranomer/hyaluronic acid copolymer (Deflux®) as first line treatment for high grade vesicoureteral reflux.Materials and Methods: Between 2001 and 2004, 692 children with a median age of 2.1 years (3 months to 13.7 years) with high grade vesicoureteral reflux underwent endoscopic subureteral injection of Deflux® soon after the diagnosis of vesicoureteral reflux was made on the initial voiding cystourethrogram. Vesicoureteral reflux was unilateral in 283 patients and bilateral in 409. Of the 1,101 ureters vesicoureteral reflux was grade II to V in 35 (3.2%), 580 (52.7%), 457 (41.5%) and 29 (2.6%), respectively. The procedure was performed on an outpatient basis. Followup ultrasound and voidi...
Yuri Reinberg - One of the best experts on this subject based on the ideXlab platform.
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Dextranomer hyaluronic acid for pediatric vesicoureteral reflux systematic review
Pediatrics, 2010Co-Authors: Jonathan C. Routh, Brant A. Inman, Yuri ReinbergAbstract:Objective Published success rates of Dextranomer/hyaluronic acid (Dx/HA) injection for pediatric vesicoureteral reflux (VUR) vary widely. Our objective of this study was to assess whether underlying patient or study factors could explain the heterogeneity in reported Dx/HA success rates. Methods We searched the Cochrane Controlled Trials Register and Medline, Embase, and Scopus databases from 1990 to 2008 for reports in any language, along with a hand search of included study bibliographies. Articles were assessed and data abstracted in duplicate, and differences were resolved by consensus. Conflict of interest (COI) was determined by published disclosure. Meta-regression was performed to adjust for patient as well as study-level factors. Results We identified 1157 reports, 89 of which were reviewed in full with 47 included in the pooled analysis. Of 7303 ureters that were injected with Dx/HA, 5633 (77%) were successfully treated according to the authors' definition. Injection success seemed to vary primarily on the basis of the preoperative reflux grade. After adjustment for VUR grade, other factors, such as the presence or absence of COI disclosure, were not significant. Studies were markedly heterogeneous overall. Conclusions The overall per-ureter Dx/HA success rate was 77% after 3 months, although success rates varied widely among studies. Increased VUR grade negatively affected success rates, whereas COI, patient age, and injected Dx/HA volume were not significantly associated with treatment outcome after adjustment for VUR grade. There is a significant need for improved reporting of VUR treatments, including comparative studies of Dx/HA and other VUR treatments.
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histopathological changes associated with Dextranomer hyaluronic acid injection for pediatric vesicoureteral reflux
The Journal of Urology, 2007Co-Authors: Jonathan C. Routh, Richard A. Ashley, Thomas J. Sebo, David R. Vandersteen, Jeffrey M. Slezak, Yuri ReinbergAbstract:Purpose: Few studies have examined the medium and long-term histological changes associated with periureteral injection of Dextranomer/hyaluronic acid copolymer (Deflux®). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing ureteroneocystostomy after failed Dextranomer/hyaluronic acid injection.Materials and Methods: All patients undergoing ureteroneocystostomy after failed Dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free Dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical ex...
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multivariate comparison of the efficacy of intraureteral versus subtrigonal techniques of Dextranomer hyaluronic acid injection
The Journal of Urology, 2007Co-Authors: Jonathan C. Routh, Richard A. Ashley, David R. Vandersteen, Yuri Reinberg, James J Wolpert, Brant A. Inman, Douglas A. Husmann, Stephen A. KramerAbstract:Purpose: Numerous factors have been postulated to increase success rates for Dextranomer/hyaluronic acid injection for vesicoureteral reflux. Ureteral hydrodistention combined with intraureteral injection reportedly improves injection success rates. We combined the results of 5 pediatric urologists to evaluate the efficacy of this technique compared to that of subtrigonal-only injection in relation to other factors.Materials and Methods: Patients with primary vesicoureteral reflux undergoing Dextranomer/hyaluronic acid injection from April 2002 to December 2005 at 2 institutions were eligible. Only patients with primary vesicoureteral reflux were included in the study. Injection success was defined as the complete absence of reflux on followup voiding cystourethrogram or radionuclide cystogram. Predictors of a successful outcome were analyzed statistically with logistic regression. Factors included in our analysis were gender, age, vesicoureteral reflux grade, dysfunctional voiding, amount of injected dex...
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postoperative ureteral obstruction after subureteral injection of Dextranomer hyaluronic acid copolymer
The Journal of Urology, 2006Co-Authors: David R. Vandersteen, Hal C. Scherz, Andrew J. Kirsch, Jonathan C. Routh, Michael L Ritchey, Ellen Shapiro, James J Wolpert, Heidi Pfefferle, Yuri ReinbergAbstract:Purpose: Subureteral injection of Dextranomer/hyaluronic acid copolymer is widely accepted for the treatment of primary vesicoureteral reflux. Few studies document the incidence of surgically relevant postoperative obstruction or the characteristics of patients at risk.Materials and Methods: Four institutions had reported surgically relevant postoperative obstruction to representatives of Q-Med Scandinavia, the manufacturers of Deflux® (Dextranomer/hyaluronic acid). All children undergoing Dextranomer/hyaluronic acid injection at these institutions were evaluated in this study. Patients requiring postoperative stenting were retrospectively reviewed for pertinent history, volume injected, technique of injection, duration of symptoms before intervention, duration of intervention and final outcome.Results: A total of 745 patients (1,155 ureters) underwent injection. Five patients (6 renal units, 7 ureters) required stenting for obstructive symptoms and hydronephrosis, of whom 4 immediately became symptomatic...