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Prospective study using a new bulking agent for the treatment of vesicoureteral reflux: polyacrylamide hydrogel
Jonathan Cloutier1, Anne-Sophie Blais, Katherine Moore
1Division of Urology, Quebec University Hospital Center, Laval University, Quebec City, Quebec, Canada.
Insights
Polyacrylamide hydrogel shows promising short-term success for pediatric vesicoureteral reflux (VUR). This endoscopic treatment offers an effective alternative, comparable to other agents, for managing VUR in children.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Biomaterials
Background:
- Vesicoureteral reflux (VUR) is common in children, often managed with endoscopic treatments.
- Current endoscopic bulking agents have high costs, prompting investigation into alternatives.
- Polyacrylamide hydrogel presents a potential cost-effective option for VUR treatment.
Purpose of the Study:
- To evaluate the efficacy and success rates of polyacrylamide hydrogel for endoscopic treatment of VUR in a pediatric cohort.
- To assess the feasibility of using polyacrylamide hydrogel as a first-line therapy for VUR.
- To compare the outcomes of polyacrylamide hydrogel with established bulking agents.
Main Methods:
- A prospective, single-center, off-label study involving 40 pediatric patients with VUR.
- Endoscopic subureteral double hydrodistention implantation using polyacrylamide hydrogel.
- Postoperative assessment at 3 months included renal ultrasound and voiding cystourethrogram to confirm VUR resolution.
Main Results:
- Successful VUR correction in 87% for low-grade (I-III) and 81.2% overall after a single treatment.
- The study included 69 refluxing ureters in 40 patients, with a median age of 50 months.
- Mean injected volume was 1.1 ml, with various grades of VUR treated.
Conclusions:
- Off-label polyacrylamide hydrogel injection is effective for low-grade pediatric VUR.
- Short-term success rates are comparable to dextranomer/hyaluronic acid.
- Further comparative trials of polyacrylamide hydrogel and dextranomer/hyaluronic acid are warranted.
Purpose:
Vesicoureteral reflux is frequently diagnosed in the pediatric population. Endoscopic treatment has become a popular form of first-line therapy. Available products offer good short-term success rates. However, the cost of these injected implants is an issue. We evaluated the success of endoscopic treatment for vesicoureteral reflux using polyacrylamide hydrogel.
Materials And Methods:
We performed a single center, single surgeon, prospective, off-label study using polyacrylamide hydrogel to treat vesicoureteral reflux. All patients underwent endoscopic subureteral double hydrodistention implantation technique injection followed by renal ultrasound and voiding cystourethrogram at 3 months postoperatively to confirm the absence of de novo hydronephrosis and correction of vesicoureteral reflux (grade 0).
Results:
A total of 40 patients (69 refluxing ureters) underwent polyacrylamide hydrogel injection. Median age at surgery was 50 months. Bilateral reflux was identified in 29 patients (73%). Nine patients had duplex systems, 2 with reflux into both moieties. Reflux was graded using the International Reflux Study in Children grading system, with grade I seen in 9 ureters, II in 17, III in 20, IV in 18 and V in 5. Mean volume injected was 1.1 ml. Success rate for grade I to III vesicoureteral reflux at 3 months after a single treatment was 87%, and the overall success for all grades was 81.2%.
Conclusions:
Off-label use of polyacrylamide hydrogel injection therapy for primarily low grade vesicoureteral reflux demonstrates that the technique and short-term success rates are comparable to the most popular bulking agent, dextranomer/hyaluronic acid. These results suggest that further trials comparing polyacrylamide hydrogel and dextranomer/hyaluronic acid would be worthwhile.
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