Histopathological changes associated with dextranomer/hyaluronic acid injection for pediatric vesicoureteral reflux.

Journal Article (Journal Article)

PURPOSE: Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux(R)). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection. MATERIALS AND METHODS: All patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical excision. RESULTS: The ureters of 16 children with a mean age of 4.5 years were examined. Median time from injection to implant excision was 8 months. Giant cell reaction was present in 94% of patients and it was typically located in the serosa. No histological or immunophenotypical feature correlated with the duration of implantation except CD3+ and CD20+ lymphocyte counts, which increased with time from injection (p = 0.06 and 0.02, respectively). CONCLUSIONS: Dextranomer/hyaluronic acid appears to be stable and safe for use after 3 to 22 months of followup of subureteral injection. The periureteral inflammatory reaction increases with time, although no increases in nuclear turnover or fibrosis were detected.

Full Text

Duke Authors

Cited Authors

  • Routh, JC; Ashley, RA; Sebo, TJ; Vandersteen, DR; Slezak, J; Reinberg, Y

Published Date

  • October 2007

Published In

Volume / Issue

  • 178 / 4 Pt 2

Start / End Page

  • 1707 - 1710

PubMed ID

  • 17707018

International Standard Serial Number (ISSN)

  • 0022-5347

Digital Object Identifier (DOI)

  • 10.1016/j.juro.2007.03.165


  • eng

Conference Location

  • United States