research article Dextranomer-Hyaluronic Acid Copolymer Injection into Transplant Ureterovesical Junction for Vesicoureteral Reflux
Hari Tunuguntla*, Kushan Radadia, Nicholas Farber, Christopher J Koprowski
Division of Urology, Robert Wood Johnson University, Hospital, New Brunswick, New Jersey, USA
*Corresponding author: Hari Tunuguntla, Associate Professor of Urology & Director, Robert Wood Johnson Place, MEB 584, New Brunswick, NJ 08901, USA. Tel: +17322358853; Fax: +17322358018; Email: tunuguha@rwjms.rutgers.edu
Received Date: 27 September, 2017; Accepted Date: 21 October, 2017; Published Date: 27October, 2017
Citation:Tunuguntla H, Radadia K, Farber N, Koprowski CJ (2017) Dextranomer-Hyaluronic Acid Copolymer Injection into Transplant Ureterovesical Junction for Vesicoureteral Reflux. J Urol Ren Dis: JURD-157.
1. Abstract
1.1. Background: Vesicoureteral reflux due to a non-anatomic ureterovesical anastomosis is commonly seen in kidney transplant patients after surgery. The current gold standard treatment of patients with high-grade vesicoureteral reflux and resulting recurrent urinary tract infections is revision of the ureterovesical anastomosis. Non-animal dextranomer-hyaluronic acid copolymer (Dx-HA) is used to treat vesicoureteral reflux in pediatric patients. Limited studies of Dx-HA injection in transplanted kidneys exist.
1.2. Objective: The objective of this study is to determine if Dx-HA injection is an effective treatment option for vesicoureteral reflux in kidney transplant patients.
1.3. Methods: Four patients were identified to have symptomatic vesicoureteral reflux after renal transplantation. Each patient received Dx-HA injection into the transplant ureterovesical junction. Baseline patient characteristics and treatment characteristics were recorded. Outcomes were assessed with regular patient follow-up.
1.4. Results: Median vesicoureteral reflux grade prior to intervention was 3. Three out of four patients were found to have improvement in symptoms including resolution of recurrent urinary tract infections. One patient developed obstruction of the ureter requiring nephrostomy tube placement for drainage of the kidney. One patient required repeat Dx-HA intervention after having symptomatic recurrent urinary tract infections 6 months after initial injection.
1.5. Conclusion: Dx-HA injection for vesicoureteral reflux in transplanted ureters can be an alternative treatment choice. Three out of four patients had clinical improvement after Dx-HA injection with one patient requiring repeat intervention. Further prospective trials with a larger patient population need to be performed to determine clinical efficacy of Dx-HA intervention for vesicoureteral reflux in transplanted ureters.
2.
Keywords: Cystoscopy;Dextranomer-hyaluronic
acid copolymer; Transplant; Ureter;Vesico-Ureteral Reflux
|
Patient |
Age |
Gender |
Transplant type |
Time between transplantation and VUR† diagnosis (months) |
Time between VUR† diagnosis and injection (months) |
Reflux grade via VCUG‡ |
Initial presentation |
|
A |
66 |
M |
Deceased donor (2013) |
10 |
3 |
1 |
Increased frequency, recurrent UTI§ |
|
B |
68 |
M |
Deceased donor (2011) |
33 |
5 |
3 |
Recurrent UTI§, mild hydronephrosis |
|
C |
57 |
M |
Live donor (2011) |
38 |
1 |
3 |
Recurrent UTI§ |
|
D |
26 |
F |
Deceased donor (2000), Live donor (2007) |
39 |
51 |
5 |
Recurrent UTI§ |
|
† VUR, vesicoureteral reflux; ‡ VCUG, voiding cystourethrography; §UTI, urinary tract infection |
|||||||
Table 1: Patient Characteristics.
|
Patient |
Total number of Dx-HA† injections |
Serum Cr pre/post (3 months) Dx-HA† (mmol/L) |
Recurrent UTI‡ after treatment? |
Complications |
Follow-up since Dx-HA† injection (months) |
|
A |
2 |
1.2/1.5 |
1st treatment - Yes |
Recurrent UTI‡ 5 months after initial tx |
18 |
|
1.5/1.8 |
2nd treatment - No |
||||
|
B |
1 |
3.6/2.8 |
No |
None |
13 |
|
C |
1 |
2.0/1.6 |
No |
None |
11 |
|
D |
1 |
1.7/3.5 |
Yes |
Obstruction, needed nephrostomy tube |
7 |
|
†Dx-HA, Dextranomer-hyaluronic acid copolymer; ‡ UTI, urinary tract infection |
|||||
Table 2: Treatment Details.