Overall outcomes and factors predicting the success of endoscopic dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux

Purpose: We aimed to evaluate the overall outcomes of endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for vesicoureteral reflux (VUR) and analyze the factors predicting success. Materials and Methods: A total 99 patients (58 males, 41 females) and 154 refluxing ureter units were treated with a endoscopic Deflux injection for VUR. At 3 months, radioisotope-voiding cystograms were performed to evaluate treatment responsiveness; success was defined as a resolving of VUR to less than grade I. We evaluated various perioperative factors such as gender, operation age, preoperative antibiotics duration, urinary tract infection, relative renal function and cortical defect, preoperative VUR grade, maximal flow rate in uroflowmetry, laterality of reflux, voiding dysfunction, constipation, orifice shape and trabeculation, injection technique, injection volume, number of punctures, and learning curve. Results: The overall success rate was 62.3% (96/154) in refluxing ureter units (50.5% in patients). According to grade of VUR, the success rate was 87.5% (8/9), 82.2% (37/45), 67.8% (38/56), 33.3% (13/39), and 16.7% (1/6) in grade I, II, III, IV, and V, respectively (p=0.001). In multivariate analysis, preoperative VUR grade and mound morphology were identified as predictive factors (p<0.05). No significant surgery-related complications developed. Conclusions: Endoscopic Deflux injection for VUR was effective for grade I-III VUR, although the cure rate was low for grade IV-V. The factors predicting success were preoperative VUR grade and mound morphology.