Clinical research of endoscopic injection dextranomer/hyaluronic acid treatment for childrenvesicoureteric reflux
Yang Zhen , Dai Kanglin , Sun Xianglun, et al
1.Department of Pediatric Surgery, the University of Hong Kong-Shenzhen Hospital, Guangdong,Shenzhen 518000, China; 2.Department of Pediatric Surgery, the University of Hong Kong-Queen MaryHospital, Hong Kong 999077, China
【Abstract】 Objective To review the clinical experience of endoscopic ureteral orifice injection ofdextranomer/hyaluronic acid (Dx/HA) in the treatment of pediatric vesicoureteral reflux. Methods This study
reviewed the clinical data of Dx/HA injections for 28 children with vesicoureteric reflux in the University of Hong
Kong-Shenzhen Hospital and the University of Hong Kong-Queen Mary Hospital from May 2015 to January
2018. The diagnosis of vesicoureteric reflux was confifirmed with voiding cystourethrogram (VCUG) at
preoperation. Three patients suffered from unilateral reflux, while 25 patients suffered from bilateral
approach was adopted if the opening was patulous. All the patients continued to receive oral antibiotics
prophylaxis until repeated VCUG at 3 months after the procedure and the treatment depended on the results.
Results The average age of the 28 patients at procedure was 4-114 months. There were 14 males and 14
females. The number of ureters in each reflux grading was as following: 2 cases for grade Ⅰ , 5 cases for grade
Ⅱ , 18 cases for grade Ⅲ , 17 cases for grade Ⅳ , and 11 cases for grade Ⅴ . The average duration of procedure
were (36±17) min (12-75 min), and average days of hospital stay were (2.3±1.3) days. 32 of 53 ureters reflux
disappeared at repeated VCUG at 3 months after the procedure. Resolution of reflux was found in 60.4% (32/53)
of patients after single injection. All the cases of grade Ⅰ and Ⅱ had got 100% resolution rate, while the resolution
rates for grade Ⅲ , Ⅳ and Ⅴ were 77.8%, 47.4% and 18.2% respectively. Two cases (four ureters) achieved
resolution after second injection, and the overall resolution rate after second injection was 67.9% (36/53). Ureteral
obstruction did not occur in all children. Conclusion Endoscopic Dx/HA injection is safe and effective for the
treatment of pediatric vesicoureteral reflux, and it is worthy of promotion and application.reflux. There were total 53 ureters during the study period. Subureteral transurethral injection (STING)approach was adopted if the ureteric opening was slit; while hydrodistension implantation technique (HIT)approach was adopted if the opening was patulous. All the patients continued to receive oral antibioticsprophylaxis until repeated VCUG at 3 months after the procedure and the treatment depended on the results.
Results The average age of the 28 patients at procedure was 4-114 months. There were 14 males and 14
females. The number of ureters in each reflux grading was as following: 2 cases for grade Ⅰ , 5 cases for grade
Ⅱ , 18 cases for grade Ⅲ , 17 cases for grade Ⅳ , and 11 cases for grade Ⅴ . The average duration of procedure
were (36±17) min (12-75 min), and average days of hospital stay were (2.3±1.3) days. 32 of 53 ureters reflux
disappeared at repeated VCUG at 3 months after the procedure. Resolution of reflux was found in 60.4% (32/53)
of patients after single injection. All the cases of grade Ⅰ and Ⅱ had got 100% resolution rate, while the resolution
rates for grade Ⅲ , Ⅳ and Ⅴ were 77.8%, 47.4% and 18.2% respectively. Two cases (four ureters) achieved
resolution after second injection, and the overall resolution rate after second injection was 67.9% (36/53). Ureteral
obstruction did not occur in all children. Conclusion Endoscopic Dx/HA injection is safe and effective for the
treatment of pediatric vesicoureteral reflux, and it is worthy of promotion and application.
2020, Vol. 8 
