A Review of Failures of Endoscopic Treatment of Vesicoureteral Reflux With Dextranomer Microspheres

James Higham-Kessler, Steven E. Reinert, Warren T. Snodgrass, Terry W. Hensle, Martin A. Koyle, Richard S. Hurwitz, Marc Cendron, David A. Diamond, Anthony A. Caldamone

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Purpose: We evaluated the appearance of the mound of failed endoscopic dextranomer microsphere injections at the time of reinjection or open ureteral reimplantation. Materials and Methods: We performed a multi-institutional study of 80 patients (97 ureters) who were diagnosed with vesicoureteral reflux and had failed endoscopic treatment with dextranomer microspheres. Observations of injected mound characteristics were made during the time of reinjection or at open ureteral reimplantation. Correlations were made with the pre-injection grade of reflux, volume of initial injection, number of punctures used for the initial injection and presence of symptoms of dysfunctional voiding. Results: Examination of the failed injection sites before subsequent injections or open surgery revealed mound abnormalities in all but 13 of the 97 ureters. Of the cases 49% demonstrated a shifted mound, 22% an absent mound and 10% a loss of volume in the mound. Of the 13 patients with normal appearing mounds 7 had improved reflux grade, 3 had worsened grade and 3 had no change. Patients with dysfunctional voiding symptoms had a second injection failure rate of 44%, compared to a 13% rate in those without symptoms of voiding dysfunction. Conclusions: Most failures of endoscopic correction are associated with mound shifting. The presence of a perfect mound does not predict success. Dysfunctional voiding predicts a lower success rate after a second injection.

Original languageEnglish
Pages (from-to)710-715
Number of pages6
JournalJournal of Urology
Volume177
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

Keywords

  • dextranomer-hyaluronic acid copolymer
  • treatment outcome
  • ureter
  • vesico-ureteral reflux

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