The outcomes of two different bulking agents (dextranomer hyaluronic acid copolymer and polyacrylate-polyalcohol copolymer) in the treatment of primary vesico-ureteral reflux

Abstract

Purpose Subureteral injection of bulking agents in the endoscopic treatment of vesicoureteral reflux is widely accepted therapy with high success rates. Although the grade of vesicoureteric reflux and experience of surgeon is the mainstay of this success, the characteristics of augmenting substances may have an effect particularly in the long term. In this retrospective study, we aimed to evaluate the clinical outcomes of the endoscopic treatment of vesicoureteric reflux (VUR) with two different bulking agents: Dextranomer/hyaluronic acid copolymer (Dx/HA) and Polyacrylate polyalcohol copolymer (PPC).Materials and Methods A total 80 patients (49 girls and 31 boys) aged 1-12 years (mean age 5.3 years) underwent endoscopic subureteral injection for correction of VUR last six years. The patients were assigned to two groups: subureteral injections of Dx/HA (45 patients and 57 ureters) and PPC (35 patients and 45 ureters). VUR was grade II in 27 ureters, grade III in 35, grade IV in 22 and grade V in 18 ureters.Results VUR was resolved in 38 (66.6%) of 57 ureters and this equates to VUR correction in 33 (73.3%) of the 45 patients in Dx/HA group. In PPC group, overall success rate was 88.8% (of 40 in 45 ureters). Thus, Thus, this equates to VUR correction in 31 (88.5%) of the 35 patients.Conclusions Our short term data show that two different bulking agent injections provide a high level of reflux resolution and this study revealed that success rate of PPC was significantly higher than Dx/HA with less material.

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

“…A high level of reflux resolution using PPC is noted. The results showed that reflux was corrected in about 90% of cases after single PPC injection, with no recurrence during prospective follow-up [ 5 , 13 , 14 , 15 , 16 , 18 , 19 ].…”

“…Recently, in 2016, were published 4 papers, which compared retrospectively the outcomes of endoscopic reflux correction using two bulking agents: dextranomer/hyaluronic acid copolymer versus polyacrylate-polyalcohol copolymer. The results revealed that success rate of PPC was significantly higher than that obtained with Dx/HA [ 16 , 17 , 18 , 19 ].…”

“…PPC is used successfully to treat primary reflux and also for complex cases [ 9 , 10 , 13 , 14 , 16 , 18 , 19 ]. The use of PPC to correct grades IV and V is also very efficient with an overall success rate achieved of over 80% [ 8 , 11 , 13 , 15 , 17 ].…”

“…Since that time PPC was introduced into clinical practice and is currently used in some centers around the world. So far, 19 publications of endoscopic treatment of vesicoureteral reflux (VUR) using PPC are available in the literature [ 2 – 19 ]. The general objective of this paper was to present 5-year experience with PPC and to evaluate its efficacy in the management of reflux in children.…”

The Results of Endoscopic Treatment of Grade IV and V Persistent Vesiocoureteral Reflux in Children Using PolyacrylatePolyalcohol Copolymer (Vantris)

“…Various bulking agents were used for this purpose: polytetrafluoroethylene (PTFE) before 2000, dextranomer/hyaluronic acid copolymer (Dx/HA, Deflux ®) since 2000 and recently polyacrylate-polyalcoholcopolymer (PPC, Vantris ®) [4,5,6,7,8,9,10,11,12]. PPC (Vantris ®) a synthetic, non-absorbable tissueaugmenting substance was introduced into clinical practice in 2010 [13] and is currently used in some centers Around the world [14,15,16,17,18,19,20].The aim of the present study was to evaluate the efficacy of PPC injection to correct reflux grade IV and V in children.…”