Long-term incidence of febrile UTI after DxHA treatment of VUR

• Published in: Journal of pediatric urology Vol. 10; no. 1; pp. 56 - 61
• Main Authors: Fotso Kamdem, Arnaud, Galli, Giacomo, Aubert, Didier
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2014
• Subjects: Antibiotic Prophylaxis; Child, Preschool; Dextranomer-hyaluronic acid copolymer; Dextrans - administration & dosage; Dextrans - adverse effects; Dextrans - therapeutic use; Endoscopic treatment; Endoscopy; Female; Fever; Humans; Hyaluronic Acid - administration & dosage; Hyaluronic Acid - adverse effects; Hyaluronic Acid - therapeutic use; Incidence; Injections, Intralesional - methods; Male; Pediatrics; Prospective Studies; Recurrence; Risk Factors; Treatment Outcome; Urinary tract infection; Urinary Tract Infections - epidemiology; Urinary Tract Infections - prevention & control; Urology; Vesico-Ureteral Reflux - drug therapy; Vesicoureteral reflux; Urinary tract infection; Dextranomer-hyaluronic acid copolymer; Endoscopic treatment; Vesicoureteral reflux; Incidence
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2013.06.002

Abstract Purpose To assess the long-term incidence of febrile urinary tract infection (fUTI) in children treated by endoscopic injection of dextranomer/hyaluronic acid (DxHA) for vesicoureteral reflux (VUR). Materials and methods Prospective study from January 2002 to December 2009 in children treated at our institution for VUR by endoscopic injection of DxHA. All children underwent clinical and renal/bladder ultrasound follow up at 3 months after procedure, then annually. Post-operative voiding cystourethrogram (VCUG) control was performed only for patients with recurrent fUTI. Results 227 children (177 female) were included. Mean patient age at inclusion was 4.7 years. The mean duration of follow-up was 51.6 months. During follow-up, 18.9% had one or several fUTIs, of whom 48.8% had VUR at VCUG. No recurrence of fUTI was observed after 4 years of follow-up. We identified three risk factors for fUTI recurrence: cystitis cystica at the time of injection ( p  = 0.007), preoperative renal scarring ( p  = 0.018), and the disappearance of the implant at 3-month follow-up ultrasound ( p  = 0.037). Conclusions The long-term incidence of recurrent fUTI after endoscopic treatment of VUR is low. Our data show that the clinical results of endoscopic treatment should be interpreted with a follow up of at least 4 years.