Prospective study using a new bulking agent for the treatment of vesicoureteral reflux: polyacrylamide hydrogel

J Urol. 2013 Sep;190(3):1034-7. doi: 10.1016/j.juro.2013.03.071. Epub 2013 Mar 26.

Abstract

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.

Keywords: DMSA; Dx/HA; PAHG; PPC; RRU; RUS; VCUG; VUR; acrylamides; dextranomer/hyaluronic acid; dimercapto-succinic acid; endoscopy; hydrogel; polyacrylamide hydrogel; polyacrylate/polyalcohol copolymer; refluxing renal unit; renal ultrasound; vesico-ureteral reflux; vesicoureteral reflux; voiding cystourethrogram.

Publication types

  • Comparative Study

MeSH terms

  • Acrylic Resins / therapeutic use*
  • Administration, Intravesical
  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cystoscopy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Hydrogels / therapeutic use
  • Infant
  • Male
  • Off-Label Use
  • Prospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome
  • Urodynamics / physiology
  • Urography / methods
  • Vesico-Ureteral Reflux / diagnosis
  • Vesico-Ureteral Reflux / drug therapy*
  • Young Adult

Substances

  • Acrylic Resins
  • Bulkamid
  • Hydrogels
  • polyacrylamide gels