Comment on Subureteral Injection with Small-Size Dextranomer/Hyaluronic Acid Copolymer: Is It Really Efficient?

Letter to the Editor

Comment on

(Subureteral Injection with

Small-Size Dextranomer/Hyaluronic Acid Copolymer:

Is It Really Efficient?

)

S. Arena

and C. Romeo

Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Viale Gazzi, AUO “Gaetano Martino”, 98124 Messina, Italy

Correspondence should be addressed to S. Arena; salarena@unime.it Received 7 February 2018; Accepted 15 July 2018; Published 12 August 2018 Academic Editor: Florian M. Wagenlehner

Copyright © 2018 S. Arena and C. Romeo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

We read with great interest and appreciated very much the article written by ¨Ure et al. [1]. In their study, the authors evaluated the efficiency of subureteral small-size (80-120𝜇m) dextranomer/hyaluronic acid copolymer injec-tion treatment in children affected by 1 to 4 grade vesi-coureteral reflux, finding an overall success rate of 97% of the treated patients. Previously, Aydogdu et al. [2], comparing small-size dextranomer/hyaluronic acid copoly-mer and deflux (normal-size dextranocopoly-mer/hyaluronic acid copolymer), showed no difference in effectiveness between these two agents with the advantage that small-size dex-tranomer/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 extracel-lular 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 ¨Ure et al. [1] are very interesting and we would like to congratulate the authors on their splendid paper.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References

[1] I. ¨Ure, S. G¨urocak, ¨O. Tan et al., “Subureteral Injection with Small-Size Dextranomer/Hyaluronic Acid Copolymer: Is It Really Efficient?” BioMed Research International, vol. 2016, Article ID 2168753, 6 pages, 2016.

[2] O. Aydogdu, C. Ozcan, B. Burgu, M. Mermerkeya, and T. Soygur, “Does the diameter of dextranomer microspheres affect the success in endoscopic treatment of vesicoureteral reflux?”

Urology, vol. 80, no. 3, pp. 703–706, 2012.

[3] S. Arena, C. Fazzari, A. Implatini et al., “Dextranomer/ Hyaluronic Acid Copolymer Implant for Vesicoureteral Reflux: Role of Myofibroblast Differentiation,” The Journal of Urology, vol. 181, no. 6, pp. 2695–2701, 2009.

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BioMed Research International Volume 2018, Article ID 4078183, 1 page https://doi.org/10.1155/2018/4078183

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