Sorensen Mathew D, Koyle Martin A, Cowan Charles A, Zamilpa Ismael, Shnorhavorian Margarett, Lendvay Thomas S
Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195, USA.
Pediatr Surg Int. 2010 May;26(5):509-13. doi: 10.1007/s00383-010-2558-9. Epub 2010 Feb 7.
Dextranomer/hyaluronic acid (Deflux) has been increasingly used for the treatment of vesicoureteral reflux (VUR). Experience has shown that injecting more volume of material is necessary to achieve greater success. We evaluate trends in the number of vials being used to treat VUR using a multi-institutional database and data from patients treated at our own institution.
Children of age 0-19 years in the Pediatric Health Information System (PHIS) database from 2003 to 2008 were extracted with a VUR diagnosis (ICD-9 593.7x) and subureteric injection procedure code (CPT 52327). We identified children with reflux treated with endoscopic injection at Seattle Children's Hospital from 2005 to 2008. Hospital trends of the number of vials used were evaluated using multivariate linear regression.
From 2003 to 2008, we identified 4,078 endoscopic injection procedures in PHIS. There was a 33% increase in the average number of vials used per patient (p < 0.0001) with more than a threefold increase in the number of patients receiving three or more vials per procedure. All institutions increased the average vials used per patient with the most pronounced increase at the highest-volume centers. These trends were also present in the 186 children treated at our own institution.
Over the study period there was an increase in the number of vials of dextranomer/hyaluronic acid being used per patient to treat children with VUR. This practice may improve success rates but will increase the cost of treatment due to the inherent expense of the material.
葡聚糖凝胶/透明质酸（Deflux）已越来越多地用于治疗膀胱输尿管反流（VUR）。经验表明，为了取得更大的成功，需要注射更多体积的材料。我们使用多机构数据库和我们自己机构治疗的患者数据，评估用于治疗VUR的药瓶数量趋势。
从2003年至2008年的儿科健康信息系统（PHIS）数据库中提取0至19岁诊断为VUR（国际疾病分类第九版593.7x）且有输尿管下注射程序代码（现行程序编码52327）的儿童。我们确定了2005年至2008年在西雅图儿童医院接受内镜注射治疗反流的儿童。使用多元线性回归评估药瓶使用数量的医院趋势。
从2早03年至2008年，我们在PHIS中确定了4078例内镜注射程序。每位患者使用的药瓶平均数量增加了33%（p<0.0001），每个程序接受三个或更多药瓶的患者数量增加了三倍多。所有机构每位患者使用的平均药瓶数量都有所增加，用量最大的中心增加最为明显。在我们自己机构治疗早的186例儿童中也出现了这些趋势。
在研究期间，用于治疗VUR儿童的每位患者的葡聚糖凝胶/透明质酸药瓶数量有所增加。这种做法可能会提高成功率，但由于材料本身的费用，会增加治疗成本。
