A Comparison of the Double Hydrodistention Implantation Technique (HIT) and the HIT with a Polyacrylate/polyalcohol Copolymer (PPC) for the Endoscopic Treatment of Primary Vesicoureteral Reflux

Overview

Journal Int Urol Nephrol

Publisher Springer

Specialty Nephrology

Date 2014 Jun 27

PMID 24966099

Citations 2

Authors

Melih Akin

Basak Erginel

Cetin Ali Karadag

Abdullah Yildiz

Gul Sumru Ozcelik

Nihat Sever

Nimetullah Mete Genc

Ali Ihsan Dokucu

Affiliations

Soon will be listed here.

Abstract

Objectives: We aimed to compare the success rates of the double hydrodistention implantation technique (HIT) and the HIT with a polyacrylate/polyalcohol copolymer (PPC) for the treatment of primary vesicoureteral reflux (VUR) with a new nonbiodegradable tissue-augmenting substance (Vantris, Promedon, Cordoba, Argentina).

Methods: Between January 2011 and December 2012, fifty-two children who underwent subureteric injection for primary VUR are included. The children were randomly separated into two groups, the HIT and the double HIT groups, according to the type of injection. Success was defined as no reflux on a follow-up voiding cystourethrogram (VCUG) after 6 months. The patients were evaluated according to sex, age, grade of reflux, number of injections, and injected volume, and the radiological success rates were compared.

Results: Fifty-two patients underwent an endoscopic injection for primary grade III-V VUR. The HIT group consisted of 26 patients with 33 ureters, and the double HIT group consisted of 26 patients with 35 ureters. There were no significant differences in terms of the sex, ages, VUR grades, bilaterality between the two groups. The mean injected volumes were ml 1.12 (1.02-1.22) in the HIT group and 1.24 ml (95 % CI 1.10-1.38) in the double HIT group. The reflux was resolved in 21/33 (63.6 %) ureters in the HIT group and in 30/35 (85.7 %) ureters in the double HIT group, (p < 0.05). We had only one complication. This patient in the double HIT group, developed bilateral hydronephrosis and oliguric renal failure requiring open reimplantation at the sixth month.

Conclusion: We observed successful results double HIT method with PPC in Grade III-V reflux, but the long-term follow-up of patients is needed for hydronephrosis. As the double HIT treatment leads to a higher success rate, its use is preferable.

Citing Articles

Interventions for primary vesicoureteric reflux.

Williams G, Hodson E, Craig J Cochrane Database Syst Rev. 2019; 2:CD001532.

PMID: 30784039 PMC: 6380991. DOI: 10.1002/14651858.CD001532.pub5.

Endoscopic correction of vesicoureteral reflux in children using polyacrylate-polyalcohol copolymer (Vantris): 5-years of prospective follow-up.

Warchol S, Krzemien G, Szmigielska A, Bombinski P, Toth K, Dudek-Warchol T Cent European J Urol. 2017; 70(3):314-319.

PMID: 29104797 PMC: 5656363. DOI: 10.5173/ceju.2017.1226.

References

Holmdahl G, Brandstrom P, Lackgren G, Sillen U, Stokland E, Jodal U . The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. J Urol. 2010; 184(1):280-5. DOI: 10.1016/j.juro.2010.01.059. View

ODonnell B, Puri P . Treatment of vesicoureteric reflux by endoscopic injection of Teflon. Br Med J (Clin Res Ed). 1984; 289(6436):7-9. PMC: 1442065. DOI: 10.1136/bmj.289.6436.7. View

Ormaechea M, Ruiz E, Denes E, Gimenez F, Denes F, Moldes J . New tissue bulking agent (polyacrylate polyalcohol) for treating vesicoureteral reflux: preliminary results in children. J Urol. 2009; 183(2):714-7. DOI: 10.1016/j.juro.2009.10.047. View

Kirsch A, Perez-Brayfield M, Smith E, Scherz H . The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol. 2004; 171(6 Pt 1):2413-6. DOI: 10.1097/01.ju.0000127754.79866.7f. View

Kirsch A, Kaye J, Cerwinka W, Watson J, Elmore J, Lyles R . Dynamic hydrodistention of the ureteral orifice: a novel grading system with high interobserver concordance and correlation with vesicoureteral reflux grade. J Urol. 2009; 182(4 Suppl):1688-92. DOI: 10.1016/j.juro.2009.02.061. View

Chertin B, Abu Arafeh W, Kocherov S . Endoscopic correction of complex cases of vesicoureteral reflux utilizing Vantris as a new non-biodegradable tissue-augmenting substance. Pediatr Surg Int. 2014; 30(4):445-8. DOI: 10.1007/s00383-014-3468-z. View

Kalisvaart J, Scherz H, Cuda S, Kaye J, Kirsch A . Intermediate to long-term follow-up indicates low risk of recurrence after Double HIT endoscopic treatment for primary vesico-ureteral reflux. J Pediatr Urol. 2011; 8(4):359-65. DOI: 10.1016/j.jpurol.2011.07.006. View

Vandersteen D, Routh J, Kirsch A, Scherz H, Ritchey M, Shapiro E . Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic Acid copolymer. J Urol. 2006; 176(4 Pt 1):1593-5. DOI: 10.1016/j.juro.2006.06.101. View

Cerwinka W, Scherz H, Kirsch A . Dynamic hydrodistention classification of the ureter and the double hit method to correct vesicoureteral reflux. Arch Esp Urol. 2008; 61(8):882-7. DOI: 10.4321/s0004-06142008000800005. View

10.

Ormaechea M, Paladini M, Pisano R, Scagliotti M, Sambuelli R, Lopez S . Vantris, a biocompatible, synthetic, non-biodegradable, easy-to-inject bulking substance. Evaluation of local tissular reaction, localized migration and long-distance migration. Arch Esp Urol. 2008; 61(2):263-8. DOI: 10.4321/s0004-06142008000200023. View

11.

MATOUSCHEK E . [Treatment of vesicorenal reflux by transurethral teflon-injection (author's transl)]. Urologe A. 1981; 20(5):263-4. View

12.

Koyle M, Elder J, Skoog S, Mattoo T, Pohl H, Reddy P . Febrile urinary tract infection, vesicoureteral reflux, and renal scarring: current controversies in approach to evaluation. Pediatr Surg Int. 2011; 27(4):337-46. DOI: 10.1007/s00383-011-2863-y. View

13.

Lackgren G, Wahlin N, Skoldenberg E, Stenberg A . Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol. 2001; 166(5):1887-92. DOI: 10.1016/s0022-5347(05)65713-8. View

14.

Yu T, Chang L . Use of collagen for endoscopic correction in complicated vesicoureteral reflux. Scand J Urol Nephrol. 2007; 41(1):58-65. DOI: 10.1080/00365590600830458. View

15.

Chertin B, Abu Arafeh W, Zeldin A, Kocherov S . Preliminary data on endoscopic treatment of vesicoureteric reflux with polyacrylate polyalcohol copolymer (Vantris®): surgical outcome following single injection. J Pediatr Urol. 2011; 7(6):654-7. DOI: 10.1016/j.jpurol.2010.11.010. View

16.

Ferrer F, McKenna P, Hochman H, Herndon A . Results of a vesicoureteral reflux practice pattern survey among American Academy of Pediatrics, Section on Pediatric Urology members. J Urol. 1998; 160(3 Pt 2):1031-7. DOI: 10.1097/00005392-199809020-00019. View