Intermediate to long-term follow-up indicates low risk of recurrence after Double HIT endoscopic treatment for primary vesico-ureteral reflux

Kalisvaart, Jonathan F.; Scherz, Hal C.; Cuda, Scott P.; Kaye, Jonathan D.; Kirsch, Andrew J.

doi:10.1016/j.jpurol.2011.07.006

Cited by 50 publications

(29 citation statements)

References 17 publications

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“…With hydrodistention, injection of the bulking agent creates a bulge, which initially coapts the detrusor tunnel, and a second implant within the most distal intramural tunnel leads to coaptation of the ureteric orifice [31]. Double HIT requires a higher injection volume and has a reported success rate of up to 93% [3233]. Results of a recent survey showed that double HIT was the most commonly used technique for endoscopic correction of VUR by pediatric urologists in the United States [34].…”

Section: Endoscopic Injection Techniquesmentioning

confidence: 99%

Endoscopic injection therapy

Kim

Lee

2017

Investig Clin Urol

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Since the U.S. Food and Drug Administration approved dextranomer/hyaluronic acid copolymer (Deflux) for the treatment of vesicoureteral reflux, endoscopic injection therapy using Deflux has become a popular alternative to open surgery and continuous antibiotic prophylaxis. Endoscopic correction with Deflux is minimally invasive, well tolerated, and provides cure rates approaching those of open surgery (i.e., approximately 80% in several studies). However, in recent years a less stringent approach to evaluating urinary tract infections (UTIs) and concerns about long-term efficacy and complications associated with endoscopic injection have limited the use of this therapy. In addition, there is little evidence supporting the efficacy of endoscopic injection therapy in preventing UTIs and vesicoureteral reflux-related renal scarring. In this report, we reviewed the current literature regarding endoscopic injection therapy and provided an updated overview of this topic.

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Section: Endoscopic Injection Techniquesmentioning

confidence: 99%

Endoscopic injection therapy

Kim

Lee

2017

Investig Clin Urol

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“…Kalisvaart et al . [20] recently reported over 90% success with double HIT technique, and reported the durability of the result on intermediate and long-term follow up. The results from our series are comparable to most of the published data in the literature.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic treatment of vesicoureteric reflux with dextranomer/hyaluronic acid copolymer (Deflux): Single-surgeon experience with 48 ureters

Chandrasekharam¹

2013

Indian J Urol

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Purpose:VUR is a common urologic problem in children. Cystoscopic injection of bulking agents (most commonly Deflux) has gained popularity as the first line treatment in the west. However, primarily due to cost factors, it has not gained much popularity in our country. We present our initial experience with cystoscopic Deflux injection for VUR.Materials and Methods:We reviewed our 3-yr experience with the use of Dx/HA (Deflux) for correction of VUR in children and adolescents. All children were evaluated with Ultrasound, MCUG and DMSA renal cortical scan. The indications for surgical correction of VUR included breakthrough infections while on antibiotic prophylaxis, persistent high-grade VUR beyond 3 yrs of age, and presence of significant renal damage on DMSA at diagnosis (in those children presenting with UTI). All children underwent cystoscopic Deflux injection using the standard technique of subureteral injection (0.4-1 ml per ureter). All children received antibiotic prophylaxis for 3-6 months after the injection. USG was done at 1 month and MCUG at 3-6 months after the injection.Results:33 patients (48 ureters) underwent cystoscopic Deflux injection for correction of VUR. Mean age was 4.5 yrs (1-17 yrs); there were 12 boys and 21 girls. Thirteen children had antenatally diagnosed HDN, while 20 children presented with febrile UTI. All children had primary VUR except one child with persistent VUR 4 yrs after PUV fulguration. The VUR was grade 1-2 in 8, grade 3-4 in 37, and grade 5 in 3 ureters. Every child had at least one ureter with dilating reflux (grades 3,4 or 5). When present, low grade VUR (grade 1or 2) was always on the contralateral side. Only one child received a 2nd injection after 6 months. Follow-up MCUG was done in 28 children (41 ureters). Complete reflux resolution was achieved in 27 ureters (65%), and the reflux was downgraded in 2 (5%). There were no complications of Deflux injection.Conclusions:Endoscopic correction of VUR in children is a safe and effective minimally invasive treatment for VUR. It stops or downgrades VUR in 70% of ureters. At present, we recommend it as a first-line treatment for grades 1-4 VUR requiring surgical management. Cost is the major factor limiting its use in our country.

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“…In recent years, the HIT procedure has been modified to include 2 tandem intraluminal ureteric tunnel injections (double HIT)34,35). Before injection, the bladder is emptied, and the ureteral orifices are hydrodistended and graded according to the hydrodistention grading system (H0-H3)36).…”

Section: Developments Of the Endoscopic Treatmentmentioning

confidence: 99%

“…The first injection is made at the 6 o'clock position mid tunnel and coapts the proximal tunnel. A second injection is made at the distal aspect of the tunnel at the location of the ureteral orifice and serves to coapt the ureteral meatus34). Kalisvaart et al34) evaluated 54 patients who underwent double HIT and revealed 93% clinical and 93% radiographic intermediate/long-term success rates.…”

Section: Developments Of the Endoscopic Treatmentmentioning

confidence: 99%

Endoscopic treatment of vesicoureteral reflux in pediatric patients

Kim

2013

Korean J Pediatr

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Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR). Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.

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Intermediate to long-term follow-up indicates low risk of recurrence after Double HIT endoscopic treatment for primary vesico-ureteral reflux

Cited by 50 publications

References 17 publications

Endoscopic injection therapy

Endoscopic injection therapy

Endoscopic treatment of vesicoureteric reflux with dextranomer/hyaluronic acid copolymer (Deflux): Single-surgeon experience with 48 ureters

Endoscopic treatment of vesicoureteral reflux in pediatric patients

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