Pediatric Urology Long-term Ultrasound Appearance of Concomitant Autologous Blood and Dextranomer/Hyaluronic Acid Copolymer Implants: Is It Associated With Successful Correction of Vesicoureteral Reflux? Abdol-Mohammad Kajbafzadeh, Zahra Aryan, Ali Tourchi, and Houman Alizadeh 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: 407e413, 2013. Ó 2013 Elsevier Inc. V esicoureteral reflux (VUR) is common among children and is associated with urinary tract infections (UTIs), pyelonephritis, renal scarring, and hypertension. 1 Endoscopic treatment of VUR using bulking agents gained popularity after 2001 with the advent of dextranomer/hyaluronic acid (Deflux). Success rate reported after dextranomer/hyaluronic acid injection varies from 60% to 92%, and persistent VURs according to failure of treatment warrants long-term follow-up of these patients. 2 Voiding cystourethrogram (VCUG), which is usually indicated during follow-up, is considered as an invasive diagnostic modality with an unfavorable affect on patients’ and parents’ concepts of the treatment process. 3 Alongside the efforts to improve the success rate of VUR correction after a minimally invasive surgery, ultrasound-based techniques are suggested to reduce the need for postoperative VCUG. 4-8 We recently presented an autologous blood injection via a hydrodistention injection technique (HIT) that carries a 98.8% success rate compared with standard HIT, with 89.4% success. 9 The autologous blood injection after Deflux implanta- tion leads to clot formation and may prevent from leakage, migration, or shrinkage of the mound. Autolo- gous blood is a safe source of fibrin sealants that may help preserve the mound. Furthermore, it has augmentation effects that enable it to act as a bulking material. 10,11 Financial Disclosure: The authors declare that they have no relevant financial interests. From the Pediatric Urology Research Center and the Department of Radiology, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran Reprint requests: Abdol-Mohammad Kajbafzadeh, M.D., 2nd Flr, No. 32, 7th St, Saadat-Abad Ave, Tehran 1998714616, Iran (IRI). E-mail: kajbafzd@sina.tums.ac.ir Submitted: August 9, 2012, accepted (with revisions): October 2, 2012 ª 2013 Elsevier Inc. 0090-4295/12/$36.00 407 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2012.10.006