Long-term outcome of 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. 41; no. 10; pp. 2855 - 2859
• Main Authors: Garcia-Aparicio, Luis, Martin-Sole, Oriol, Capdevila-Vilaro, Blanca, Perez-Bertolez, Sonia
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2023; Springer Nature B.V
• Subjects: Endoscopy; Follow-Up Studies; Humans; Hyaluronic acid; Hyaluronic Acid - therapeutic use; Medicine; Medicine & Public Health; Nephrology; Oncology; Original Article; Patients; Polyacrylate; Retrospective Studies; Treatment Outcome; Ureteral Obstruction - surgery; Urology; Vesico-Ureteral Reflux - surgery; Polyacrylate-polyalcohol copolymer; Dextranomer/hyaluronic acid copolymer; Endoscopic treatment; Vesicoureteral reflux
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-023-04548-z

Objective
The aim of our study is to compare long-term outcome of endoscopic treatment of VUR using PPC or Dx/HA.
Patients and methods
From October 2014 to April 2017 patients with VUR grades from 3 to 5 that needed endoscopic treatment were eligible for this RCT.
Patients were randomized in two groups: PPC and Dx/HA. A VCUG was performed at 6 months; if VUR > 3 was still present a second ET was performed.
We included for this long-term follow-up study those patients that were successfully treated at short-term follow-up. At 36 months postoperative VCUG was performed to assess outcome.
Success was considered if postoperative VUR grade was 0 at 36 months, and there was no ureteral obstruction.
Results
In the previous study, 60/73 ureters were successfully treated in 36/44 patients, and then we have analyzed 60 ureters in 36 patients. Three patients were lost in long-term follow-up, and then we analyzed 57 ureters in 33 patients divided. PPC group 18 patients (28 ureters); and Dx/HA group 15 patients (29 ureters).
After 3 years of follow-up the VCUG showed a success rate of 26/28 of RU in PPC and 26/29 of DX/HA. Two RU in PPC group had ureteral obstruction, and then the successful rate for PPC group dropped to 24/28.
The overall successful rate at long-term was 72.7% of the RU in PPC group and 70.3% in Dx/HA group.
Conclusion
PPC and Dx/HA has similar long-term outcome in VUR resolution, but ureteral obstruction could be present at long-term follow-up in PPC group.