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Keywords:

  • dextranomer and hyaluronic acid copolymer;
  • renal transplantation;
  • urinary tract infections;
  • ureteral obstruction;
  • vesico-ureteric reflux

Study Type – Therapy (case series)

Level of Evidence 4

What’s known on the subject? and What does the study add?

Vesicoureteral reflux (VUR) after renal transplantation may cause recurrent urinary tract infections (UTIs) and loss of renal function with consecutive risk of progressive graft damage. There are only a few series on the therapeutic success of dextranomer/hyaluronic acid copolymer treatment by transurethral injection. We assessed whether transurethral endoscopic therapy is an alternative strategy treating VUR in this special patient collective and we found out that this surgical method is a minimally invasive and efficient procedure with reflux resolution rate of approximately 60% after one and 79% after two injections with significant reduction of postoperative UTIs on short-term follow up.

OBJECTIVE

• To evaluate the success of endoscopic dextranomer/hyaluronic acid copolymer (DHAC) application in the treatment of patients with recurrent urinary tract infections (UTIs) and vesico-ureteric reflux (VUR) into the transplanted graft after renal transplantation.

PATIENTS AND METHODS

• Between January 2008 and April 2009, 19 patients with recurrent UTIs presented VUR proven by voiding cystourethrography.

• To correct VUR of the transplanted ureter, DHAC was injected endoscopically using hydrodistention technique.

• Pre- and postoperative serum creatinine levels, the number of pre- and postoperative UTIs, postoperative complications and reflux resolution rate were recorded. The mean follow-up was 6.5 months.

RESULTS

• The average number of UTIs was reduced significantly from 4.89 (range 2–14) to 1.31 (range 0–4) on pre- and postoperative follow-up, respectively, of 6 months (P < 0.001). The success rate increased from 57.9% after the first injection to 78.9% after the second injection.

• The remaining four patients with residual VUR received long-term low dose antibiotic prophylaxis. In total, two (10.5%) patients developed increasing creatinine levels postoperatively as a result of distal ureteral obstruction, and temporary urinary drainage was necessary in both patients.

CONCLUSIONS

• DHAC appears to be an efficient and minimal invasive method for treating VUR after renal transplantation with respect to short-term success.

• Further investigation with a larger group of patients and longer follow-up is needed to evaluate the prolonged effect, as well as any potential side effects.