Urinary Tract Infection Following Successful Dextranomer/Hyaluronic Acid Injection for Vesicoureteral Reflux

Abstract

Patients with more than 3 pre-injection infections were 8.5 times more likely than those with 1 pre-injection infection to have post-injection symptomatic urinary tract infection. Overall rates of symptomatic and febrile infections after dextranomer/hyaluronic acid reflux resolution were similar to those reported following ureteral reimplantation.

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

“…7 Chi et al noted 24% incidence of symptomatic UTI, onehalf of these were febrile (12%) after reflux resolution with Dx/HA injection in a median follow-up of 2.6 years. 8 In their study of 40 children who had successful endoscopic Dx/HA injection, Elmore et al reported an incidence of 5% febrile UTIs after correction of VUR with endoscopic treatment. 6 Sedberry-Ross et al reported an incidence of 27% of febrile UTI after endoscopic treatment in their series of 45 patients after a median follow-up of 2.9 years and 2.5 years for the infection-free group and the infection group, respectively.…”

“…7 Chi et al showed that girls, children with recurrent preoperative UTIs, older children, and children with voiding dysfunction were more likely to have a UTI after endoscopic treatment. 8 They also performed univariate analysis and found that the number of preoperative UTIs and dysfunctional voiding were significant predictors of post-injection UTI. With their multivariate analysis, however, only recurrent preoperative UTI was found to be an independent risk factor.…”

“…Febrile UTIs after successful resolution of VUR have been reported at rates as low as 2.2% to as high as 27% of patients. [4][5][6][7][8][9] The aim of this study was to determine the incidence of febrile UTIs in a large cohort of patients with intermediate and high-grade VUR treated endoscopically. …”

Medical versus surgical management for vesicoureteric reflux: the case for medical management

“…Seen from a different perspective, surgical correction alone carries the risk of disregarding important risk factors leading to problems down the road despite the initial radiological "success." 13,31,32 Addressing pelvic floor dynamics, fluid intake and elimination habits [33][34][35][36] can carry more weight (and potentially have a longer duration of benefit) than some of the surgical procedures we offer.…”

“…[41][42][43] The more recently introduced and widely embraced approach, endoscopic injection, has a more uncertain track record, particularly in terms of preventing long-term complications and durability. 31,33,[44][45][46] Moreover, the patient population has changed and increasingly includes children diagnosed based on the presence of antenatal hydronephrosis with a potentially lower risk of progressive renal damage (the "diagnostic shift" recently discussed by Peters 30 ). Accordingly, I would propose to opt for the non-invasive option until we categorically prove superiority or become wise at selecting those who need no treatment, those who will do fine with ABP and those who benefit from early surgery.…”