SUBURETERAL INJECTION OF DEXTRANOMER/HYALOURONIC ACID COPOLYMER VERSUS EXTRAVESICAL REIMPLANTATION IN TREATMENT OF PRIMARY VESICOURETERAL REFLUX IN CHILDREN: A COMPARATIVE STUDY
Eldamanhory H, Salih E, Selmy G, and Galal H.
Al Azhar University Hospital, Urology Department, Cairo.
Purpose: In this study, we aim to compare the outcomes of Dextranomer/hyaluronic acid (Dx/Ha;Dexell®) and extravesical reimplantation (Lich-Gregoir) procedures for primary VUR grades III & IV in children. Materials and Methods: A total of 60 patients were prospectively enrolled in a comparative intervention study between June 2015 and February 2018. They were randomly allocated into 2 groups, where Dexell injection was used in Group A (30 patients with 45 renal units) and Lich-Gregoir in Group B (30 patients with 48 renal units). Patients were followed with voiding cystourethrography at 3 to 6 months and renal ultrasonography at 1,3 months and at 1 year. The primary outcome was surgical success (resolution vs nonresolution), and secondary outcomes included occurrence of adverse events. Results: All patients completed 1 year follow up. The overall resolution rates based on the number of renal refluxing units studied was 77.8% (after single injection) and 81.2% in group A and group B, respectively. There were no significant differences between the groups in terms of preoperative clinical or anatomical variables (p < 0.001). The operative time in group B was significantly higher than group A (110.4±19.7 and 28.5±7.3 min, respectively, p = 0.001). The mean hospital stay was also longer in group B than group A (3.4±1.1 days and 1 day, respectively, p < 0.001). Complications after injection in Group A included fever (10.0%), UTI (20.0%) and one case with ureteral obstruction (3.0%), while in Group B included fever (20.0%), UTI (16.7%) and also one case with ureteral obstruction (3.0%). Conclusion: Our relatively short-term data show that injection therapy with Dexell® or extravesical reimplantation (Lich-Gregoir) procedures to treat vesicoureteral reflux, can be used with comparable efficacy to each other.