Outcome Analysis of Mini-Ureteroneocystostomy Versus Dextranomer/Hyaluronic Acid Copolymer Injection for Unilateral Vesicoureteral Reflux

Purpose

Injecting dextranomer/hyaluronic acid copolymer has gained popularity as first line treatment for vesicoureteral reflux. However, ureteroneocystostomy has typically been more successful than endoscopic treatments. We evaluated the outcome of dextranomer/hyaluronic acid copolymer injection vs that of extravesical ureteroneocystostomy via a 2 cm inguinal incision (mini-ureteroneocystostomy) for unilateral vesicoureteral reflux.

Materials and Methods

The records were analyzed of all patients from 2003 to 2007 with unilateral vesicoureteral reflux who underwent mini-ureteroneocystostomy or dextranomer/hyaluronic acid copolymer injection. Mini-ureteroneocystostomy was performed via a 2 cm inguinal incision. Of the injections 66% were delivered via an intraureteral tunnel technique. Statistical analysis was done to compare differences in clinical features and success rates. All p values were 2-sided with significance at p <0.05.

Results

From 2003 to 2007, 99 children underwent operative repair of unilateral vesicoureteral reflux, including 42 via dextranomer/hyaluronic acid copolymer injection and 57 via mini-ureteroneocystostomy. There were no significant differences between the groups in terms of preoperative clinical or anatomical variables except for higher preoperative reflux grade in the mini-ureteroneocystostomy cohort (p <0.001). Patients undergoing mini-ureteroneocystostomy were more likely to be cured (100% vs 78%, p = 0.001). De novo contralateral vesicoureteral reflux occurred in the 2 cohorts to a similar degree (p = 0.15). The injection cohort was more likely to be discharged home on an outpatient basis (100% vs 82%, p = 0.002). No complications occurred in the dextranomer/hyaluronic acid copolymer cohort, while 2 children required intervention for complications after mini-ureteroneocystostomy.

Conclusions

This study details that the 2 procedures may be successfully performed in the outpatient setting, and yet even for more advanced vesicoureteral reflux mini-ureteroneocystostomy achieves greater overall success. This procedure has become our standard of care for unilateral vesicoureteral reflux.

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

Abbreviations and Acronyms: Dx/HA, dextranomer/hyaluronic acid copolymer, UNC, ureteroneocystostomy, VCUG, voiding cystourethrogram, VUR, vesicoureteral reflux