Comment on “Subureteral Injection with Small-Size DextranomerHyaluronic Acid Copolymer: Is It Really Efficient?”

Abstract EN

We read with great interest and appreciated very much the article written by Üre et al.

[1].

In their study, the authors evaluated the efficiency of subureteral small-size (80-120 μm) dextranomer/hyaluronic acid copolymer injection treatment in children affected by 1 to 4 grade vesicoureteral reflux, finding an overall success rate of 97% of the treated patients.

Previously, Aydogdu et al.

[2], comparing small-size dextranomer/hyaluronic acid copolymer and deflux (normal-size dextranomer/hyaluronic acid copolymer), showed no difference in effectiveness between these two agents with the advantage that small-size dextranomer/hyaluronic acid copolymer treatment was less expensive.

It has been described that 80-250 μm-diameter dextranomer microspheres in a stabilized hyaluronic acid gel recruited numerous myofibroblasts around the dextranomer particles, a foreign body inflammatory reaction with a high density in CD68 positive cells, stimulating an enhancement in collagenous stroma [3].

Moreover, it has been suggested that accumulation of fibrillar collagen and subsequent extracellular matrix after normal-size dextranomer/hyaluronic acid copolymer injection might explain the tissue contraction in refluxing ureteral ending, modifying the ureteral length-to-diameter ratio and promoting the resolution of vesico-ureteral reflux [3].

We believe that it could be interesting to also study the histological changes in ureteral endings after small-size dextranomer/hyaluronic acid copolymer injection, to verify if this substance has a similar effect of refluxing ureteral tissue.

Finally, in our opinion, the data of Üre et al.

[1] are very interesting and we would like to congratulate the authors on their splendid paper.