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Learning From the Learning Curve: Factors Associated With Successful Endoscopic Correction of Vesicoureteral Reflux Using Dextranomer/Hyaluronic Acid Copolymer

2008; Lippincott Williams & Wilkins; Volume: 180; Issue: 4S Linguagem: Inglês

10.1016/j.juro.2008.03.084

1527-3792

Sumit Davé, Armando J. Lorenzo, Antoine E. Khoury, Luis H. Braga, Sean J. Skeldon, Mohammed Suoub, Walid A. Farhat, João L. Pippi Salle, Darius Bägli,

Urinary Bladder and Prostate Research

No AccessJournal of UrologyVesicoureteral Reflux1 Oct 2008Learning From the Learning Curve: Factors Associated With Successful Endoscopic Correction of Vesicoureteral Reflux Using Dextranomer/Hyaluronic Acid Copolymer Sumit Dave, Armando J. Lorenzo, Antoine E. Khoury, Luis H.P. Braga, Sean J. Skeldon, Mohammed Suoub, Walid Farhat, João L. Pippi Salle, and Darius J. Bägli Sumit DaveSumit Dave , Armando J. LorenzoArmando J. Lorenzo , Antoine E. KhouryAntoine E. Khoury , Luis H.P. BragaLuis H.P. Braga , Sean J. SkeldonSean J. Skeldon , Mohammed SuoubMohammed Suoub , Walid FarhatWalid Farhat , João L. Pippi SalleJoão L. Pippi Salle , and Darius J. BägliDarius J. Bägli View All Author Informationhttps://doi.org/10.1016/j.juro.2008.03.084AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Conflicting reports exist regarding the parameters guiding successful correction of vesicoureteral reflux using dextranomer/hyaluronic acid copolymer. We performed logistic regression analysis to evaluate the effect of injected volume while adjusting for other factors potentially associated with success following dextranomer/hyaluronic acid copolymer injection. Materials and Methods: Between July 2003 and June 2006, 126 consecutive patients (34 boys and 92 girls) with a mean ± SD age of 6.5 ± 3.7 years with primary vesicoureteral reflux (196 refluxing ureters) underwent injection for febrile urinary tract infections. Success was defined as complete reflux resolution. Age, gender, laterality, preoperative vesicoureteral reflux grade, surgeon experience, dextranomer/hyaluronic acid copolymer volume, time to surgery from initial presentation and preoperative treatment for lower urinary tract symptoms were analyzed. Results: Vesicoureteral reflux grade was I to V in 7 (3.5%), 53 (27%), 91 (46.4%), 30 (15.3%) and 15 renal units (7.6%), respectively. The success rate after 1 injection was 50% by patient and 59.2% by ureter. Mean injected volume was 0.9 ± 0.27 ml in those who had a successful injection vs 0.67 ± 0.24 ml in those in whom injection failed (p <0.001). The success rate after 1 injection was 78.9% using 0.8 ml or greater dextranomer/hyaluronic acid copolymer compared to 31.7% with less than 0.8 ml. Multivariate analysis confirmed that higher dextranomer/hyaluronic acid copolymer volume (p = 0.001), lower preoperative grade (p = 0.013), surgeon experience (p = 0.025) and treatment for lower urinary tract symptoms (p = 0.009) were associated with successful correction of vesicoureteral reflux. Conclusions: Our analysis strengthens the previously reported association of surgeon experience and vesicoureteral reflux grade with successful endoscopic vesicoureteral reflux correction. The data also revealed an association between injected volume and vesicoureteral reflux correction even while controlling for other variables, highlighting its importance as a true success modifier. References 1 : The modified Sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol2004; 171: 2413. 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Link, Google Scholar Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada© 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byRaju G, Marks A, Benoit R and Docimo S (2012) Models of Care for Vesicoureteral Reflux With and Without an End Point of Reflux Resolution: A Computer Cost AnalysisJournal of Urology, VOL. 189, NO. 6, (2287-2292), Online publication date: 1-Jun-2013.Hidas G, Soltani T, Watts B, Pribish M and Khoury A (2012) 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.Palmer B, Ramji F, Snyder C, Hemphill M, Kropp B and Frimberger D (2011) Voiding Cystourethrogram—Are Our Protocols the Same?Journal of Urology, VOL. 186, NO. 4S, (1668-1671), Online publication date: 1-Oct-2011.Sparks S, DeCambre M, Christman M, Kaplan G and Holmes N (2011) Salvage Ureteral Reimplantation After Failure of Dextranomer/Hyaluronic Acid InjectionJournal of Urology, VOL. 186, NO. 1, (257-260), Online publication date: 1-Jul-2011.Nelson C, Copp H, Lai J and Saigal C (2009) Is Availability of Endoscopy Changing Initial Management of Vesicoureteral Reflux?Journal of Urology, VOL. 182, NO. 3, (1152-1157), Online publication date: 1-Sep-2009. Volume 180Issue 4SOctober 2008Page: 1594-1600 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsdextranomer/hyaluronic acid copolymerureterurination disordersvesico-ureteral refluxendoscopyMetricsAuthor Information Sumit Dave Equal study contribution. More articles by this author Armando J. Lorenzo Equal study contribution. More articles by this author Antoine E. Khoury More articles by this author Luis H.P. Braga More articles by this author Sean J. Skeldon More articles by this author Mohammed Suoub More articles by this author Walid Farhat More articles by this author João L. Pippi Salle More articles by this author Darius J. Bägli More articles by this author Expand All Advertisement PDF downloadLoading ...