Back to Fall Congress

BACKGROUND: Some patients with LUT dysfunction and vesicoureteral reflux (VUR) continue to have febrile UTIs, VUR, and/or LUT symptoms despite both appropriate targeted therapy (TT) to their specific LUT condition and antibiotic prophylaxis. There has been hesitancy to use subureteric dextranomer/hyaluronic acid copolymer (DXHA) in this scenario because of the limited number of published studies, the possibility of less success, and the manufacturer’s recommendations contraindicating its use in patients with active LUT dysfunction. We report on our experience using DXHA in this subset of patients including those whose VUR persisted despite amelioration of their LUTS during treatment.
METHODS: We reviewed all patients diagnosed with both a LUT condition and VUR who underwent treatment with subureteric DXHA. Persistence of VUR was diagnosed by VUDS or VCUG and all patients were on TT and antibiotic prophylaxis prior to DXHA injection (see table 1). VUR was reassessed by VUDS or VCUG post-injection.
RESULTS: Fifteen patients (22 ureters, 21F, 1M; mean age 6.1 years, range 4-12) underwent DXHA injection. Reasons for DXHA included recurrent infections despite resolution of LUTS (n=7), renal scarring on imagining (n=1), and persistent LUTS and VUR despite TT (n=7). VUR resolved in 19 ureters (86%) and improved by at least 2 grades in 3 ureters (14%) after 1 to 3 DXHA injections. VUR resolved in 8 of 9 ureters in DV patients (89%), 5 of 9 (56%) ureters in IDOD patients, and 4 of 4 (100%) ureters in DUD patients (table 2).
CONCLUSIONS: Though currently contraindicated, DXHA is safe and effective in resolving VUR in children with associated LUT dysfunction, even before their LUT condition has fully resolved. Highest resolution rates were noted in patients with either DV or DUD or who were least symptomatic prior to injection.