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Abstract
Purpose
We aimed to evaluate the overall outcomes of endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for vesicoureteral reflux (VUR) and analyze the factors predicting success.
Materials and Methods
A total 99 patients (58 males, 41 females) and 154 refluxing ureter units were treated with a endoscopic Deflux injection for VUR. At 3 months, radioisotope-voiding cystograms were performed to evaluate treatment responsiveness; success was defined as a resolving of VUR to less than grade I. We evaluated various perioperative factors such as gender, operation age, preoperative antibiotics duration, urinary tract infection, relative renal function and cortical defect, preoperative VUR grade, maximal flow rate in uroflowmetry, laterality of reflux, voiding dysfunction, constipation, orifice shape and trabeculation, injection technique, injection volume, number of punctures, and learning curve.
Results
The overall success rate was 62.3% (96/154) in refluxing ureter units (50.5% in patients). According to grade of VUR, the success rate was 87.5% (8/9), 82.2% (37/45), 67.8% (38/56), 33.3% (13/39), and 16.7% (1/6) in grade I, II, III, IV, and V, respectively (p=0.001). In multivariate analysis, preoperative VUR grade and mound morphology were identified as predictive factors (p＜0.05). No significant surgery-related complications developed.
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Table 1.
The success rates and predictive factors in refluxing ureter units
| No. success (%) | No. failure (%) | p-value* | |
|---|---|---|---|
| Grade† | 0.001 | ||
| I | 7 (87.5) | 1 (12.5) | |
| II | 37 (82.2) | 8 (17.8) | |
| III | 38 (67.8) | 18 (32.2) | |
| IV | 13 (33.3) | 26 (66.7) | |
| V | 1 (16.7) | 5 (83.3) | |
| Orifice type | 0.519 | ||
| Normal | 23 (56.1) | 18 (43.9) | |
| Stadium | 5 (55.6) | 4 (44.4) | |
| Horseshoe | 52 (63.4) | 30 (36.6) | |
| Golf hole | 11 (50.0) | 11 (50.0) | |
| Injection volume (cc) | 0.985 | ||
| ＜0.5 | 16 (59.3) | 11 (40.7) | |
| 0.6-1.0 | 45 (58.4) | 32 (41.6) | |
| ＞1.1 | 30 (60.0) | 20 (40.0) | |
| Injection technique | 0.026 | ||
| STING | 55 (55.6) | 44 (44.4) | |
| Combined | 36 (65.4) | 19 (34.6) | |
| No. of punctures | 0.173 | ||
| 1 | 36 (56.3) | 28 (43.8) | |
| 2-3 | 49 (58.3) | 35 (41.7) | |
| ＞4 | 6 (100.0) | 0 (0) | |
| Mound morphology† | 0.023 | ||
| Satisfactory | 80 (64.0) | 45 (36.0) | |
| Unsatisfactory | 9 (30.0) | 21 (70.0) |
Table 2.
The success rates and predictive factors of Deflux injection in patients with vesicoureteral reflux
| No. success (%) | No. failure (%) | p-value* | |
|---|---|---|---|
| Gender | 0.31 | ||
| Male | 29 (50.0) | 29 (50.0) | |
| Female | 21 (51.2) | 20 (48.8) | |
| Operation age (months) | 0.02 | ||
| ＜36 | 2 (14.3) | 12 (85.7) | |
| 36-60 | 18 (58.1) | 13 (41.9) | |
| ＞60 | 30 (55.6) | 24 (44.4) | |
| Laterality | 0.01 | ||
| Unilateral | 27 (61.4) | 17 (38.6) | |
| Bilateral | 23 (41.8) | 32 (58.2) | |
| Dysfunctional voiding | 0.45 | ||
| Yes | 26 (61.9) | 16 (38.1) | |
| No | 4 (50.0) | 4 (50.0) | |
| Constipation | 0.73 | ||
| Yes | 23 (62.2) | 14 (37.8) | |
| No | 8 (57.1) | 6 (42.9) |
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