Transurethral Injection Therapy with Dextranomer/Hyaluronic Acid Copolymer (Deflux<sup>®</sup>) for Treatment of Secondary Vesicoureteral Reflux after Renal Transplantation

Seifert, H.; Mazzola, Brunello; Ruszat, R.; Müller, A.; Steiger, Jürg; Bachmann, Alexander; Sulser, Tullio

doi:10.1089/end.2007.0020

Cited by 29 publications

(12 citation statements)

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“…It has been used extensively in children with primary VUR with success rates up to 85% [35]. The first Deflux series for transplant-associated VUR was published in 2007 [36]. Four women with deteriorating renal function attributed to VUR were treated.…”

Section: Resultsmentioning

confidence: 99%

The Current Role of Endourologic Management of Renal Transplantation Complications

Duty

Conlin

Fuchs

et al. 2013

Advances in Urology

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Introduction. Complications following renal transplantation include ureteral obstruction, urinary leak and fistula, urinary retention, urolithiasis, and vesicoureteral reflux. These complications have traditionally been managed with open surgical correction, but minimally invasive techniques are being utilized frequently. Materials and Methods. A literature review was performed on the use of endourologic techniques for the management of urologic transplant complications. Results. Ureterovesical anastomotic stricture is the most common long-term urologic complication following renal transplantation. Direct vision endoureterotomy is successful in up to 79% of cases. Urinary leak is the most frequent renal transplant complication early in the postoperative period. Up to 62% of patients have been successfully treated with maximal decompression (nephrostomy tube, ureteral stent, and Foley catheter). Excellent outcomes have been reported following transurethral resection of the prostate shortly after transplantation for patients with urinary retention. Vesicoureteral reflux after renal transplant is common. Deflux injection has been shown to resolve reflux in up to 90% of patients with low-grade disease in the absence of high pressure voiding. Donor-gifted and de novo transplant calculi may be managed with shock wave, ureteroscopic, or percutaneous lithotripsy. Conclusions. Recent advances in equipment and technique have allowed many transplant patients with complications to be effectively managed endoscopically.

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Section: Resultsmentioning

confidence: 99%

The Current Role of Endourologic Management of Renal Transplantation Complications

Duty

Conlin

Fuchs

et al. 2013

Advances in Urology

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“…This includes endoluminal laser treatment for ureteral strictures, providing a 60% chance of success (17). In case of persistent reflux after redo-ureterocystostomy, reflux could be improved by endoscopic injection of polymers in small series (18).…”

Section: Discussionmentioning

confidence: 99%

Treatment of ureteral complications after kidney transplantation with native ureteropyelostomy reduces the risk of pyelonephritis

Lehmann

Müller

Schiesser

et al. 2011

Clinical Transplantation

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Urological complications contribute to morbidity and graft loss after kidney transplantation. Aim of this study was to assess the role of revisional surgery on patient outcome. From 1997 to 2007, 887 patients underwent kidney transplantation in our institution. Clinical data of patients with urological complications were analyzed. Ureteral complications were observed in 50 of 887 (5.6%) recipients, including ureteral necrosis (0.9%), stenosis (3.6%) and ureteral reflux with recurrent graft pyelonephritis (1.1%). Thirty-five patients underwent native ureteropyelostomy, and 14 patients had redo-ureterocystostomy. All patients treated for recurrent graft pyelonephritis had no further episodes. Overall, the rate of ureteral stenosis was significantly higher after secondary surgery, compared to the primary anastomosis (10% vs. 3.6%, p = 0.039). A significantly lower incidence of graft pyelonephritis was observed in patients after native ureteropyelostomy compared to patients treated with redo-ureterocystostomy (p = 0.019). In conclusion, reflux and recurrent graft pyelonephritis can be treated effectively by secondary surgery. The use of native ureteropyelostomy may offer protection from graft pyelonephritis after secondary surgery.

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“…The transurethral injection of Deflux® (dextranomer/hyaluronic acid copolymer, Q‐med Scandinavia, Uppsala, Sweden) in adult kidney transplant patients eliminating the symptomatic reflux was described in 2007 in four patients by Seifert et al . [18], where three of four patients, after 36 months of follow‐up, showed no VUR on VCUG with a significant reduction of UTIs. Transurethral application of DHAC therefore appears to represent an efficient and minimally invasive treatment option in addition to antibiotic long‐term prophylaxis and ureteral reimplantation surgery for the treatment of secondary VUR after renal transplantation [18].…”

Section: Discussionmentioning

confidence: 91%

“…[18], where three of four patients, after 36 months of follow‐up, showed no VUR on VCUG with a significant reduction of UTIs. Transurethral application of DHAC therefore appears to represent an efficient and minimally invasive treatment option in addition to antibiotic long‐term prophylaxis and ureteral reimplantation surgery for the treatment of secondary VUR after renal transplantation [18].…”

Section: Discussionmentioning

confidence: 91%

“…Scarring of the implantation site as well as the non‐orthotopic position of the ureteral orifice at the sidewall or dome of the bladder with difficult accessibility for the endoscopic needle appear to comprise reasons for the lower success rates. Pushing down the dome of the bladder through the impression of the lower abdomen as well as the use of a flexible guidewire may compensate for these difficulties [18]. An additional factor explaining the decreased success rates as well as postoperative recurrent UTIs comprises an inadequately treated coexisting bladder dysfunction [20].…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic application of dextranomer/hyaluronic acid copolymer in the treatment of vesico‐ureteric reflux after renal transplantation

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Vesicoureteral reflux (VUR) after renal transplantation may cause recurrent urinary tract infections (UTIs) and loss of renal function with consecutive risk of progressive graft damage. There are only a few series on the therapeutic success of dextranomer/hyaluronic acid copolymer treatment by transurethral injection. We assessed whether transurethral endoscopic therapy is an alternative strategy treating VUR in this special patient collective and we found out that this surgical method is a minimally invasive and efficient procedure with reflux resolution rate of approximately 60% after one and 79% after two injections with significant reduction of postoperative UTIs on short‐term follow up. OBJECTIVE • To evaluate the success of endoscopic dextranomer/hyaluronic acid copolymer (DHAC) application in the treatment of patients with recurrent urinary tract infections (UTIs) and vesico‐ureteric reflux (VUR) into the transplanted graft after renal transplantation. PATIENTS AND METHODS • Between January 2008 and April 2009, 19 patients with recurrent UTIs presented VUR proven by voiding cystourethrography. • To correct VUR of the transplanted ureter, DHAC was injected endoscopically using hydrodistention technique. • Pre‐ and postoperative serum creatinine levels, the number of pre‐ and postoperative UTIs, postoperative complications and reflux resolution rate were recorded. The mean follow‐up was 6.5 months. RESULTS • The average number of UTIs was reduced significantly from 4.89 (range 2–14) to 1.31 (range 0–4) on pre‐ and postoperative follow‐up, respectively, of 6 months (P < 0.001). The success rate increased from 57.9% after the first injection to 78.9% after the second injection. • The remaining four patients with residual VUR received long‐term low dose antibiotic prophylaxis. In total, two (10.5%) patients developed increasing creatinine levels postoperatively as a result of distal ureteral obstruction, and temporary urinary drainage was necessary in both patients. CONCLUSIONS • DHAC appears to be an efficient and minimal invasive method for treating VUR after renal transplantation with respect to short‐term success. • Further investigation with a larger group of patients and longer follow‐up is needed to evaluate the prolonged effect, as well as any potential side effects.

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Transurethral Injection Therapy with Dextranomer/Hyaluronic Acid Copolymer (Deflux^®) for Treatment of Secondary Vesicoureteral Reflux after Renal Transplantation

Abstract: Transurethral injection therapy with Deflux is a minimally invasive treatment option for patients with SVUR after renal transplantation. A second treatment seems to be necessary in some cases. Complications such as ureteral obstruction may occur.

Cited by 29 publications

References 13 publications

The Current Role of Endourologic Management of Renal Transplantation Complications

The Current Role of Endourologic Management of Renal Transplantation Complications

Treatment of ureteral complications after kidney transplantation with native ureteropyelostomy reduces the risk of pyelonephritis

Endoscopic application of dextranomer/hyaluronic acid copolymer in the treatment of vesico‐ureteric reflux after renal transplantation

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Transurethral Injection Therapy with Dextranomer/Hyaluronic Acid Copolymer (Deflux®) for Treatment of Secondary Vesicoureteral Reflux after Renal Transplantation

Abstract: Transurethral injection therapy with Deflux is a minimally invasive treatment option for patients with SVUR after renal transplantation. A second treatment seems to be necessary in some cases. Complications such as ureteral obstruction may occur.

Cited by 29 publications

References 13 publications

The Current Role of Endourologic Management of Renal Transplantation Complications

The Current Role of Endourologic Management of Renal Transplantation Complications

Treatment of ureteral complications after kidney transplantation with native ureteropyelostomy reduces the risk of pyelonephritis

Endoscopic application of dextranomer/hyaluronic acid copolymer in the treatment of vesico‐ureteric reflux after renal transplantation

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Transurethral Injection Therapy with Dextranomer/Hyaluronic Acid Copolymer (Deflux^®) for Treatment of Secondary Vesicoureteral Reflux after Renal Transplantation