Endoscopic Injections Could Improve VUR

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Treatment with hyaluronic acid/dextranomer gel resolves VUR cases

 

Endoscopic injection of hyaluronic acid/dextranomer (NASHA/Dx) gel can be considered as a first-line option for vesicoureteral reflux (VUR) in children, researchers say.

 

Richard N. Yu, MD, and David R. Roth, MD, of the Baylor College of Medicine in Houston, studied this approach in 107 patients with a mean age of 4.1 years and a median reflux grade of II. The mean time to follow-up cystourethrogram was about 10 weeks. VUR was resolved in 82.2% of patients and nearly 87% of ureters after initial endoscopic injection of NASHA/Dx (Deflux, Q-MedAB). Following a second treatment for 14 patients, the overall resolution rate was 90.7%. No patient underwent open surgery.

 

“An important advantage to this approach to treatment is that many children are spared the trauma and risk of complications associated with open surgery,” the authors wrote in Pediatrics (2006;118:698-703).

 

NASHA/Dx gel consists of cross-linked dextranomer microspheres suspended in a 1% carrier gel

of non-animal stabilized hyaluronic acid. The FDA approved NASHA/ Dx gel for pediatric VUR (grades II-IV) in 2001.

 

In a previous study published in the Journal of Pediatrics (2002;140:230-234), researchers who compared NASHA/Dx gel with anti-biotic prophylaxis in children with VUR grade II-IV found that 69% of those treated with NASHA/Dx gel had a reflux grade of I or less bilaterally compared with 38% in the antibiotic-prophylaxis group.

 

Drs. Hu and Roth cited two studies suggesting that parents prefer the endoscopic approach to open surgery and antibiotic prophylaxis. In a study published in BJU International (2003;92:285-288), Italian investigators surveyed parents of 100 children with grade III reflux. They provided parents with detailed information about the three treatment options, including mode of action, cure rate, and possible complications, as well as practice advantages and disadvantages. Eighty percent of parents said they preferred the endoscopic treatment, whereas 5% preferred antibiotic prophylaxis, 2% preferred open surgery, and 13% could not decide.

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