Journal of Urology and Renal Diseases (ISSN: 2575-7903)

Article / 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

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 VURdiagnosis (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 UTIafter 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.

1.       Romero NP, Romo MIG, Vegas ÁG, Izquierdo JB, Varela JC, et al. (2010) Deflux Injections for Vesicoureteral Reflux in Transplanted Kidneys. Transplantation Proceedings 42: 2892-2895.

2.       Seifert HH, Mazzola B, Ruszat R, Muller A, Steiger J, et al. (2007) Transurethral injection therapy with dextranomer/hyaluronic acid copolymer (Deflux) for treatment of secondary vesicoureteral reflux after renal transplantation. J Endourol 21: 1357-1360.

3.       Yucel S, Akin Y, Celik O, Erdogru T, Baykara M (2010) Endoscopic vesicoureteral reflux correction in transplanted kidneys: does injection technique matter? J Endourol 24: 1661-1664.

4.       Stenberg AM, Sundin A, Larsson BS, Lackgren G, Stenberg A (1997) Lack of distant migration after injection of a 125iodine labeled dextranomer based implant into the rabbit bladder. J Urol158:1937-1941.

5.       Seifert H-H, Mazzola B, Zellweger T, Ruszat R, Muller A, et al. (2006) Ureteral obstruction after dextranomer/hyaluronic acid copolymer injection for treatment of secondary vesicoureteral reflux after renal transplantation. Urology 68: 203-218.

6.       Mastrosimone S, Pignata G, Maresca MC, Calconi G, Rabassini A, et al. (1993) Clinical significance of vesicoureteral reflux after kidney transplantation. ClinNephrol40:38-45.

7.       Vianello A, Pignata G, Caldato C, Di Falco G, Calconi G, et al. (1997) Vesicoureteral reflux after kidney transplantation: clinical significance in the medium to long-term. ClinNephrol47:356-361.

8.       Cloix P, Gelet A, Desmettre O, Cochat P, Garnier JL, et al. (1993) Endoscopic treatment of vesicoureteric reflux in transplanted kidneys. British journal of urology 72:20-22.

9.       Mallet R, Game X, Mouzin M, Sarramon JP, Vaessen C, et al. (2003)Symptomatic vesicoureteral reflux in kidney transplantation: results of endoscopic injections of teflon and predictive factors for success. Progresenurologie: journal de l'Associationfrancaised'urologie et de la Societefrancaised'urologie 13:598-601.

10.    Latchamsetty KC, Mital D, Jensik S, Coogan CL (2003) Use of collagen injections for vesicoureteral reflux in transplanted kidneys. Transplant Proc35:1378-1380.

11.    Perez-Brayfield M, Kirsch AJ, Hensle TW, Koyle MA, Furness P, et al. (2004) Endoscopic treatment with dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux. J Urol172:1614-1616.

12.    Jung C, DeMarco RT, Lowrance WT, Pope JCt, Adams MC, et al. (2007)Subureteral injection of dextranomer/hyaluronic acid copolymer for persistent vesicoureteral reflux following ureteroneocystostomy. J Urol177:312-315.

13.    Pichler R, Buttazzoni A, Rehder P, Bartsch G, Steiner H, et al. (2011) Endoscopic application of dextranomer/hyaluronic acid copolymer in the treatment of vesico-ureteric reflux after renal transplantation. BJU international 107:1967-1972.

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 DisJURD-157.

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