ENDOSCOPIC TREATMENT OF SECONDARY VESICOURETERAL REFLUX USING VURDEX

Dite Z.. Kocvara R., Sedlacek J., Drlik M., Hanus T.

Charles' Univ. Hospital, Dept. of Urology, Prague, Czech Republic

Introduction & Objectives: Objectives. To evaluate therapeutical effect of dextranomer/hyaluronic acid copolymer (Vurdex®) in children with secondary vesicoureteral reflux (VUR) with posterior urethral valves (PUV) or voiding dysfunction (VD).

Material & Methods: Methods. Between 1/2005 and 4/2009, 26 children with secondary VUR were treated by endoscopic instillation of Vurdex®. After retrospective review, two groups of children were created. Group I: Nine boys (0 age 3.5 years) demonstrated persistent high-grade VUR at 016 months after PUV ablation, seven had unilateral and two bilateral VUR (11 ureteral units - UU). Reflux was grade IV in five (45.5%) and grade V in six UU (54.5%). In four UU simple intraureteral instillation, in three subureteral instillation and in four double hit was performed using 0.6 to 1.0 cc (0 0.8) of Vurdex®.

Results: Results. Group I: After a single injection of Vurdex® VUR disappeared in 5(45.5%) and was improved (grade l-ll) in 4 (36.4%) UU. No upper tract obstruction or urinary tract infection was found during 018,4 months of follow-up. Group 2: VUR disappeared in 10 (55.6%) after a single injection, and was improved in 6 (33.3 %) UU. During 026.8 months of follow-up, two girles (13.2 %) had urinary tract infection (one febrile and next one non-febrile). In one girl contralateral VUR grade I. was found. No adverse effects were registered.

Conclusions: Conclusions. The endoscopic instillation of dextranomer/hyaluronic acid copolymer (Vurdex®) is an effective and safe alternative for the management of secondary VUR persisting after the treatment of posterior urethral valves or lower urinary tract dysfunction.

Eur Urol Suppl 2010;9(6):647