Endoscopic injection of non-animal-stabilized hyaluronic acid/dextranomer gel (HA/Dx) is a highly effective treatment for vesicoureteral reflux (VUR) in children and should be considered as a first-line treatment option, researchers concluded.

Michael H. Hsieh, MD, PhD, now with the Stanford University School of Medicine in Stanford, Calif., and colleagues studied 178 children with VUR (mean age 4.2 years) treated with this approach by a single surgeon at the Baylor College of Medicine in Houston.

At least two months after treatment, patients were to return for a voiding cystourethrogram (VCUG) assessment.After initial treatment, 12 patients were lost to follow-up or had yet to undergo a VCUG, leaving an efficacy population of 166 patients. In this group, the surgeon, David R. Roth, MD, treated 265 ureters (252 refluxing and 13 non-refluxing). Reflux resolved in 81.9% of subjects and 86.4% of ureters after a single treatment, according to a report in Urology (2009; published online ahead of print).

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After a second treatment, the proportions increased to 89.6% and 95.6%, respectively. After a third treatment, the proportions rose slightly to 90.2% and 96%. The procedures were associated with few complications.HA/Dx gel became the first material approved by the FDA for endoscopic injection in children with grade 2-4 VUR, the authors noted. Endoscopic injection of the gel usually is performed on an outpatient basis. It requires no incision and can be performed quickly.