Randomized clinical trial between polyacrylate-polyalcohol copolymer (PPC) and dextranomer-hyaluronic acid copolymer (Dx/HA) as bulking agents for endoscopic treatment of primary vesicoureteral reflux (VUR)

• Published in: World journal of urology Vol. 36; no. 10; pp. 1651 - 1656
• Main Authors: García-Aparicio, L., Blázquez-Gómez, E., Martin, O., Pérez-Bertólez, S., Arboleda, J., Soria, A., Tarrado, X.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2018; Springer Nature B.V
• Subjects: Child; Child, Preschool; Clinical trials; Cystography; Cystoscopy; Dextrans - administration & dosage; Endoscopy; Female; Fibrosis; Follow-Up Studies; Humans; Hyaluronic acid; Hyaluronic Acid - administration & dosage; Hydronephrosis - diagnostic imaging; Injections; Male; Medicine; Medicine & Public Health; Nephrology; Oncology; Original Article; Patients; Polyacrylate; Polymers - administration & dosage; Success; Tomography, X-Ray Computed; Treatment Outcome; Ureter; Urinary tract; Urology; Vesico-Ureteral Reflux - diagnostic imaging; Vesico-Ureteral Reflux - therapy; Polyacrylate-polyalcohol copolymer; Dextranomer/hyaluronic acid copolymer; Endoscopic treatment; Vesicoureteral reflux
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-018-2314-7

Objective
To compare the radiological and clinical outcomes of endoscopic treatment of primary VUR using polyacrylate-polyalcohol copolymer (PPC-Vantris
®
) or dextranomer-hyaluronic acid copolymer (Dx/HA-Deflux
®
).
Materials and methods
From October 2014 to April 2017, patients with primary VUR grade III to V that needed endoscopic treatment (ET) were eligible for this randomized clinical trial. We excluded toilet-trained patients with lower urinary tract symptoms. Patients were randomized and allocated into two groups: PPC group and Dx/HA group. After endoscopic treatment a voiding cystourethrography (VCUG) was performed at 6 months; if VUR was still present a second ET was performed. Radiological success was considered if postoperative VUR grade was 0 and clinical success rate was considered if no more fUTI appeared during follow-up.
Results
Forty-six patients were eligible but 2 did not accept the trial. Forty-four patients with 73 refluxing ureters were included. PPC: 34 refluxing ureters; and Dx/HA: 39 refluxing ureters. Both groups were statistically homogeneous and comparable. Mean follow-up was 27.6 months. Radiological success rate (82.2%) and clinical success rate (92.3%) were similar in both groups (
p
 > 0.05). The volume of bulking agent used in those successfully treated was greater in Dx/HA group (
p
 < 0.05). Distal ureter was excise in all cases of ureteral reimplantation after PPC treatment; however, distal ureter was preserved in all ureters reimplanted after Dx/HA injection.
Conclusion
PPC and Dx/HA had similar outcomes, but we must warn that ureteral reimplantation after endoscopic treatment with PPC is difficult because of the periureteral fibrosis.