Dextranomer/hyaluronic injection for the management of vesicoureteric reflux in complete ureteral duplication: should age and gender be factors in decision making?

The injection of dextranomer/hyaluronic acid (DHA) has become an accepted treatment for children with vesicoureteral reflux (VUR). Complete ureteral duplication has been considered by some practitioners as counterindication for its use. We reviewed the Texas Children's Hospital (TCH) records for children with complete ureteral duplication who were treated with DHA for VUR. We searched medical records at TCH for patients with a preoperative diagnosis of complete ureteral duplication who had undergone DHA injection between January 1, 2001, and October 15, 2008. Operative notes, imaging studies, and clinic notes were reviewed. In this period, 28 kidneys in 24 children were treated. The average grade of reflux before injection was 3.44 (range 1-5). First injection resolution of reflux was 57% with an increase to 73% after a second injection with an average volume of DHA of 1.05 mL. New contralateral VUR developed postinjection in three (15%) children with unilateral VUR. There were no perioperative complications. The average age of the children who were treated was 41.4 months. Mean follow-up was 45.94 months. Success of DHA injection tended to be higher in girls (65%) and older children. High levels of success can be achieved with DHA injection in children with complete ureteral duplication. DHA injection is more likely to be successful for older girls with VUR and complete ureteral duplication. If initial injection does not result in VUR resolution, a second injection offers an opportunity for improved success. For physicians and families who are seeking an alternative to open surgical management, DHA represents an attractive option for selected children with complete ureteral duplication.