Permanent versus Biodegradable Bulking Agents for Paediatric Vesicoureteral Reflux

Abstract Objectives To compare long-term outcomes after endoscopic treatment of paediatric primary vesicoureteral reflux using a permanent polyacrylate-polyalcohol copolymer and a biodegradable dextranomer/hyaluronic acid agent. Methods This retrospective two-centre cohort study included 83 children treated over a two-year period and followed for six years. Forty-five children received polyacrylate-polyalcohol copolymer and 38 received dextranomer/hyaluronic acid. Outcomes included protocol-defined success, grade-specific success, reintervention, reintervention-free survival, postoperative urinary tract infection, obstruction, and direct material costs. Results Overall protocol-defined success was 68.9% with polyacrylate-polyalcohol copolymer and 63.2% with dextranomer/hyaluronic acid ( p = 0.645). In grade IV reflux, success was higher with polyacrylate-polyalcohol copolymer (88.2% versus 50.0%; p = 0.017; odds ratio, 7.50). Reintervention was required in 13.3% and 36.8% of patients, respectively ( p = 0.020; number needed to treat, 5). Reintervention-free survival at 60 months was 88.2% and 39.0%, respectively (log-rank p = 0.004). Documented urinary tract infection decreased significantly after treatment in the overall cohort (84.3% to 43.4%; p < 0.001). Conclusion In this retrospective centre-linked cohort, polyacrylate-polyalcohol copolymer was associated with fewer reinterventions and more durable long-term reintervention-free survival than dextranomer/hyaluronic acid. The strongest efficacy signal was observed in grade IV reflux. Because treatment allocation was centre-linked and postoperative imaging protocols differed between centres, these findings should be interpreted as real-world cohort data rather than as definitive evidence of universal material superiority. Grade V reflux outcomes require particularly cautious interpretation.