Endoscopic treatment for vesicoureteral reflux: How important is technique?

Sean T. Watters, Jennifer Sung, Steven J. Skoog

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Purpose Endoscopic dextranomer/hyaluronic acid (Dx/HA) injection by subureteric transurethral injection (STING) or hydrodistention implantation technique (HIT) for treatment of vesicoureteral reflux (VUR) has variable results with HIT reporting better outcomes. We determined outcomes with each technique comparing reflux resolution rates and evaluating predictors of treatment success and failure. Methods Univariate and multivariate analysis compared 163 patients (246 ureters) who underwent a single endoscopic Dx/HA injection from December 2001 to April 2010. Data on pre, peri, and post-operative variables were prospectively collected. Resolution was defined as no reflux on voiding cystourethrogram (VCUG) at 3 month follow up. Calculated ellipsoid volume (CEV) of Dx/HA mounds was defined as (4/3π(height/2) × (length/2) × (width/2)) based on post-operative ultrasound dimensions. Results Ureter resolution was 79.75% and 80.84% for STING and HIT, respectively (p = 0.86). Patient resolution was 70.0% and 74.3% for STING and HIT, respectively (p = 0.57). Multivariate ureter analysis revealed lower pre-operative grade (p = 0.004) and injected Dx/HA volume 0.80-1.00 mL (p = 0.039) as predictors of success. CEV <0.20 mL (p = 0.002) and CEV/injected-volume <25% (p = 0.006) were predictors of failure. Volcano morphology (p = 0.004) and lower pre-op grade (p = 0.015) were predictors of success for STING and HIT, respectively. Conclusions We found no differences in ureter or patient resolution between endoscopic Dx/HA injection techniques STING or HIT. Lower pre-operative grade and moderated Dx/HA volume were predictors of success regardless of technique.

Original languageEnglish (US)
Pages (from-to)1192-1197
Number of pages6
JournalJournal of Pediatric Urology
Issue number6 PART B
StatePublished - Dec 2013
Externally publishedYes


  • Dextranomer/hyaluronic acid
  • HIT
  • Urinary tract infection
  • Vesicoureteral reflux

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology


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