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Randomized Clinical Trial Between Polyacrylate-Polyalcohol Copolymer (PPC) and Dextranomer-Hyaluronic Acid Copolymer (Dx/HA) as Bulking Agents for Endoscopic Treatment of Primary Vesicoureteral Reflux (VUR)

Randomized Clinical Trial Between Polyacrylate-Polyalcohol Copolymer (PPC) and Dextranomer-Hyaluronic Acid Copolymer (Dx/HA) as Bulking Agents for Endoscopic Treatment of Primary Vesicoureteral Reflux (VUR)

L García-Aparicio, E Blázquez-Gómez, O Martin, S Pérez-Bertólez, J Arboleda, A Soria, X Tarrado

World J Urol. 2018 Oct;36(10):1651-1656.

PMID: 29725806

Abstract:

Objective:
To compare the radiological and clinical outcomes of endoscopic treatment of primary VUR using polyacrylate-polyalcohol copolymer (PPC-Vantris®) or dextranomer-hyaluronic acid copolymer (Dx/HA-Deflux®).
Materials and methods:
From October 2014 to April 2017, patients with primary VUR grade III to V that needed endoscopic treatment (ET) were eligible for this randomized clinical trial. We excluded toilet-trained patients with lower urinary tract symptoms. Patients were randomized and allocated into two groups: PPC group and Dx/HA group. After endoscopic treatment a voiding cystourethrography (VCUG) was performed at 6 months; if VUR was still present a second ET was performed. Radiological success was considered if postoperative VUR grade was 0 and clinical success rate was considered if no more fUTI appeared during follow-up.
Results:
Forty-six patients were eligible but 2 did not accept the trial. Forty-four patients with 73 refluxing ureters were included. PPC: 34 refluxing ureters; and Dx/HA: 39 refluxing ureters. Both groups were statistically homogeneous and comparable. Mean follow-up was 27.6 months. Radiological success rate (82.2%) and clinical success rate (92.3%) were similar in both groups (p > 0.05). The volume of bulking agent used in those successfully treated was greater in Dx/HA group (p < 0.05). Distal ureter was excise in all cases of ureteral reimplantation after PPC treatment; however, distal ureter was preserved in all ureters reimplanted after Dx/HA injection.
Conclusion:
PPC and Dx/HA had similar outcomes, but we must warn that ureteral reimplantation after endoscopic treatment with PPC is difficult because of the periureteral fibrosis.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
IAR42411056	Polyacrylate-polyalcohol			Price

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