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Injection volumes of dextranomer/hyaluronic acid are increasing in the endoscopic management of vesicoureteral reflux

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Abstract

Purpose

Dextranomer/hyaluronic acid (Deflux®) has been increasingly used for the treatment of vesicoureteral reflux (VUR). Experience has shown that injecting more volume of material is necessary to achieve greater success. We evaluate trends in the number of vials being used to treat VUR using a multi-institutional database and data from patients treated at our own institution.

Methods

Children of age 0–19 years in the Pediatric Health Information System (PHIS) database from 2003 to 2008 were extracted with a VUR diagnosis (ICD-9 593.7x) and subureteric injection procedure code (CPT 52327). We identified children with reflux treated with endoscopic injection at Seattle Children’s Hospital from 2005 to 2008. Hospital trends of the number of vials used were evaluated using multivariate linear regression.

Results

From 2003 to 2008, we identified 4,078 endoscopic injection procedures in PHIS. There was a 33% increase in the average number of vials used per patient (p < 0.0001) with more than a threefold increase in the number of patients receiving three or more vials per procedure. All institutions increased the average vials used per patient with the most pronounced increase at the highest-volume centers. These trends were also present in the 186 children treated at our own institution.

Conclusion

Over the study period there was an increase in the number of vials of dextranomer/hyaluronic acid being used per patient to treat children with VUR. This practice may improve success rates but will increase the cost of treatment due to the inherent expense of the material.

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Abbreviations

VUR:

Vesicoureteral reflux

PHIS:

Pediatric health information system

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Acknowledgments

The authors would like to acknowledge and thank Michael Porter, MD, MS, for his advice and statistical expertise, and Carrie Wachob for her assistance generating the figures.

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Correspondence to Mathew D. Sorensen.

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Sorensen, M.D., Koyle, M.A., Cowan, C.A. et al. Injection volumes of dextranomer/hyaluronic acid are increasing in the endoscopic management of vesicoureteral reflux. Pediatr Surg Int 26, 509–513 (2010). https://doi.org/10.1007/s00383-010-2558-9

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  • DOI: https://doi.org/10.1007/s00383-010-2558-9

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