Intra-Orifice Versus Hydrodistention Implantation Technique in Dextranomer/Hyaluronic Acid Injection for Vesicoureteral Reflux

Purpose

Original implantation procedures used dextranomer/hyaluronic acid to create a volcano-like mound at the orifice. Subsequently the hydrodistention implantation technique was described to coapt the intramural ureteral wall with less emphasis on achieving a mound at the orifice and it was reported to be associated with improved outcomes. We compared the results of intra-orifice injection to establish a mound vs the hydrodistention implantation technique.

Materials and Methods

Univariate and multivariate logistic regression analysis was used to compare results in 96 ureters undergoing intra-orifice injection vs 52 undergoing the hydrodistention implantation technique. We evaluated patient gender and age, reflux grade, injection technique, injected volume and the number of injection sites.

Results

Successful reflux resolution was achieved in 124 ureters (84%) with a single implantation, including 83 (86.5%) with intra-orifice injection and 41 (79%) with HIT (p = 0.23). Mean injected volume was significantly increased for the hydrodistention implantation technique vs intra-orifice injection (0.68 vs 0.51 cc, p = 0.002). Univariate analysis showed that female gender, older age, reflux grade and number of injection sites were associated with success. On multivariate analysis only reflux grade remained significant.

Conclusions

Despite using an increased volume of dextranomer/hyaluronic acid to coapt the intramural ureter and orifice, the hydrodistention implantation technique did not improve results over those of intra-orifice injection with a lesser implant volume.

Key Words: urinary bladder, ureter, vesico-ureteral reflux, dextranomer/hyaluronic acid copolymer

Abbreviations and Acronyms: Dx/HA, dextranomer/hyaluronic acid, HIT, hydrodistention implantation technique, STING, subureteral polytetrafluoroethylene injection