Polyacrylamide Hydrogel as a Bulking Agent for the Endoscopic Treatment of Vesicoureteral Reflux: Long-Term Results and Safety

Ramsay, Sophie; Blais, Anne‐Sophie; Morin, Fannie; Moore, Katherine; Cloutier, Jonathan; Bolduc, Stéphane

doi:10.1016/j.juro.2016.08.093

Cited by 7 publications

(10 citation statements)

References 29 publications

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“…Finally, only few published series are available on PAHG. [32][33][34] The success rate with this bulking agent appears promising, but more trials are needed prior to extensive use.…”

Section: Bulking Agentsmentioning

confidence: 99%

Vesicoureteral reflux: From prophylaxis to surgery

Blais¹,

Bolduc²,

Moore³

2017

CUAJ

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Vesicoureteral reflux (VUR) is one of the most common pathologies encountered in pediatric urology. Better understanding of the evolution of VUR and new endoscopic surgical techniques in the last decades have led to major changes in the management of this pathology. However, the treatment algorithm remains complex and is composed of a wide variety of options, from active surveillance to surgical treatment. Herein, we propose to review treatment options for VUR in order to help clinicians make the right treatment decision for the right patient.

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“…Finally, only few published series are available on PAHG. [32][33][34] The success rate with this bulking agent appears promising, but more trials are needed prior to extensive use.…”

Section: Bulking Agentsmentioning

confidence: 99%

Vesicoureteral reflux: From prophylaxis to surgery

Blais¹,

Bolduc²,

Moore³

2017

CUAJ

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“…In a metaanalysis published in 2016, the overall resolution rate ranged between 71 and 83%, depending on the injection technique. Studies with long-term follow-up [3-22 years, mostly performed with NASHA/Dx (Deflux)] have similarly reported resolution rates ranging between 69 and 100% (28, [85][86][87][88]. In addition to results in "uncomplicated" VUR, numerous studies have provided evidence that endoscopic injection is also effective in specific patient populations that may be deemed more difficult to treat (historically not considered for endoscopic therapy).…”

Section: Endoscopic Injectionmentioning

confidence: 99%

“…Intra-operative costs were highest with endoscopic injection, but the total cost (intra-operative plus post-operative hospitalization costs) was highest with the Cohen procedure (e8201), and similar with endoscopic treatment and laparoscopic reimplantation (e3283 and e3211, respectively). Observations regarding lower product costs with polyacrylamide hydrogel and smallsize dextranomer/hyaluronic acid copolymer vs. NASHA/Dx have been made in some publications (88,123,129). Simple comparisons of product costs do not provide a complete pharmacoeconomic picture: formal studies that include the total long-term costs of patient management (influenced by long-term safety and efficacy of the treatments concerned) are needed for true pharmacoeconomic comparisons.…”

Section: Endoscopic Injectionmentioning

confidence: 99%

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

et al. 2021

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Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. We review advancements over the last two decades in our understanding and management of VUR. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often involved. Some factors that increase the likelihood of persistence (e.g., high grade) also increase the risk of renal scarring. Voiding cystourethrography (VCUG) is generally considered the definitive method for diagnosing VUR, and helpful in determining the need for treatment. However, this procedure causes distress and radiation exposure. Therefore, strategies to reduce clinicians' reliance upon VCUG (e.g., after a VUR treatment procedure) have been developed. There are several options for managing patients with VUR. Observation is suitable only for patients at low risk of renal injury. Antibiotic prophylaxis can reduce the incidence of UTIs, but drawbacks such as antibiotic resistance and incomplete adherence mean that this option is not viable for long-term use. Long-term studies of endoscopic injection have helped us understand factors influencing use and the effectiveness of this procedure. Ureteral reimplantation is still performed commonly, and robot-assisted laparoscopic methods are gaining popularity. Over the last 20 years, there has been a shift toward more conservative management of VUR with an individualized, risk-based approach. For continued treatment improvement, better identification of children at risk of renal scarring, robust evidence regarding the available interventions, and an improved VUR grading system are needed.

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“…Treatment of VUR by endoscopic injection of PAHG obtained approval in Canada in October 2017, which is currently the only country to have given this approval 33 . Three contemporary studies have evaluated the use of PAHG injections in endoscopic treatment in VUR 21,34,35 .…”

Section: Polyacrylamide Hydrogel As An Alternative Bulking Agent For Vurmentioning

confidence: 99%

“…The last trial from the same institution was published by Ramsay et al in 2017 and evaluated the long-term results and safety of PAHG in endoscopic treatment of VUR 35 . A prospective single-surgeon study was designed to evaluate PAHG in endoscopic treatment of grade I to V VUR.…”

Section: Polyacrylamide Hydrogel As An Alternative Bulking Agent For Vurmentioning

confidence: 99%

Use of Polyacrylamide Hydrogel for Vesicoureteral Reflux Treatment, a Review

Lemire

Blais²,

Moore³

et al. 2019

J Nephrol Sci

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Purpose of the review: Vesicoureteral reflux (VUR) is a common pathology encountered in pediatric urology. If left untreated, this condition can lead to infectious complications, hypertension and loss of renal function by scars. There is a trend for minimally invasive procedures to minimise treatment-related complications. Endoscopic subureteral injection of bulking agent in the treatment of VUR is an example of minimally invasive options. Several bulking agents have been studied and the perfect agent has not yet been discovered. Polyacrylamide hydrogel is a relatively new agent used to treat VUR and its use will be reviewed. Recent findings: Three modern studies from a Canadian group have evaluated the use of polyacrylamide hydrogel for endoscopic injection to treat VUR. The first study reported a cure rate of 81.2% without major complication. In the second study, injection of polyacrylamide hydrogel was compared to dextranomer hyaluronic acid and no significant difference was observed, with overall success rate of 73.1% and 77.5% respectively. The third trial evaluated the long-term efficacy and safety of polyacrylamide hydrogel with a 36-month follow-up. Overall success at 3 months was 70.7% and no patient had de novo hydronephrosis or calcification of the agent at 36 months. Conclusion: Polyacrylamide hydrogel seems to be a safe and effective alternative bulking agent in the treatment of VUR. The contribution from other centers to validate those data would be valuable.

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Polyacrylamide Hydrogel as a Bulking Agent for the Endoscopic Treatment of Vesicoureteral Reflux: Long-Term Results and Safety

Cited by 7 publications

References 29 publications

Vesicoureteral reflux: From prophylaxis to surgery

Vesicoureteral reflux: From prophylaxis to surgery

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

Use of Polyacrylamide Hydrogel for Vesicoureteral Reflux Treatment, a Review

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