Long-term incidence of febrile UTI after DxHA treatment of VUR

Purpose: To assess the long-term incidence of febrile urinary tract infection (fUTI) in children treated by endoscopic injection of dextranomer/hyaluronic acid (DxHA) for vesicoureteral reflux (VUR). Materials and methods: Prospective study from January 2002 to December 2009 in children treated at our institution for VUR by endoscopic injection of DxHA. All children underwent clinical and renal/bladder ultrasound follow up at 3 months after procedure, then annually. Postoperative voiding cystourethrogram (VCUG) control was performed only for patients with recurrent fUTI. Results: 227 children (177 female) were included. Mean patient age at inclusion was 4.7 years. The mean duration of follow-up was 51.6 months. During follow-up, 18.9% had one or several fUTIs, of whom 48.8% had VUR at VCUG. No recurrence of fUTI was observed after 4 years of follow-up. We identified three risk factors for fUTI recurrence: cystitis cystica at the time of injection (p = 0.007), preoperative renal scarring (p = 0.018), and the disappearance of the implant at 3-month follow-up ultrasound (p = 0.037). Conclusions: The long-term incidence of recurrent fUTI after endoscopic treatment of VUR is low. Our data show that the clinical results of endoscopic treatment should be interpreted with a follow up of at least 4 years. (c) 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.