Long-term Ultrasound Appearance of Concomitant Autologous Blood and Dextranomer/Hyaluronic Acid Copolymer Implants: Is It Associated With Successful Correction of Vesicoureteral Reflux?

OBJECTIVE To find the association between mound appearance on ultrasound imaging and successful correction of vesicoureteral reflux (VUR). METHODS We retrospectively reviewed the ultrasound and voiding cystourethrogram (VCUG) results of patients who underwent dextranomer/hyaluronic acid injection via the hydrodistention injection technique (HIT) or HIT with concomitant autologous blood injection (HABIT) for 5 years postoperatively. VUR resolution at postoperative VCUG was considered as a success. Retained volumes of implants were measured and compared between HABIT and HIT and successful and failed treatments. Presence of mound on ultrasound imaging was also evaluated as a predictor of VUR resolution on VCUG. RESULTS Measured mound volume was significantly higher in treatments that were successful than in those that were failures (P < .05). During 5-year follow-up, measured mound volumes in the HABIT group were significantly higher than in the HIT group (P < .05). Sensitivity, specificity, positive predictive value, and negative predictive value of mound visualization on the first-month sonography to predict success were 97.7%, 21.5%, 89.6%, and 60%, respectively. These results were dramatically changed for the 50 patients with further VCUG after 1 year of follow-up, with 95.7% sensitivity, 37.0% specificity, 54.0% positive predictive value, and 90.9% negative predictive value. CONCLUSION Reduction or absence of the mound after implantation is more frequent among failed treatments in which visualization of the mound on postoperative sonography can predict VUR resolution. Autologous blood injection concomitant with dextranomer/hyaluronic acid implantation results in better immediate and long-term mound preservation, which could possibly be the reason for the higher success rate in HABIT group. UROLOGY 81: 407-413, 2013. (C) 2013 Elsevier Inc.