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Could the Implantation of Dextranomer/Hyaluronic Acid Cause the Elevation of Neuron-Specific Enolase in Children Treated for Vesicoureteral Reflux?

  • Iva Bilić Čače1,2
  • Ana Milardović1,2
  • Harry Nikolić3,4
  • Ana Bosak Veršić3,4
  • Ivona Butorac Ahel1,2

1Pediatric Clinic, Clinical Hospital Centre Rijeka, Croatia

2Department of Pediatrics, University of Rijeka, Faculty of Medicine, Rijeka, Croatia

3Department of Child Surgery, University Hospital Centre Rijeka, Croatia

4Department of Surgery, University of Rijeka, Faculty of Medicine, Rijeka, Croatia

DOI: 10.22514/sv.2020.16.0025 Vol.16,Issue 1,June 2020 pp.183-185

Published: 30 June 2020

*Corresponding Author(s): Iva Bilić Čače E-mail:


Background: Dextranomer/hyaluronic acid copolymer (Dx/HA) has been the most widely used bulking agent for the endoscopic treatment of vesicoureteral reflux. Case presentation: Here we report on a case of an 18-month-old male who underwent endoscopic treatment with Dx/HA for persistent high-grade unilateral vesicoureteral reflux (VUR). Three months later, due to the reappearance of contralateral VUR and indicated endoscopic treatment, a second cystoscopy was performed. A submucosal, well-vascularized mass localized on the left trigone and anteromedially to the left orifice was noted. Since it differed from the other similar implants previously detected on cystoscopy, it was misdiagnosed with a bladder tumor, indicating further evaluation. Extensive laboratory and imaging studies revealed normal findings, apart from high levels of neuron-specific enolase (NSE). A hypothesis made at that point was that the elevated level of NSE is due to the implantation of the Dx/HA. To test the hypothesis, two other healthy children previously treated with a Dx/HA implant were identified and their NSE levels measured. In both cases, the levels of NSE were elevated. Conclusion: The presented cases revealed that elevated levels of NSE are most likely due to a previous implantation of Dx/HA. This observation should be taken into consideration whenever there is a tentative diagnosis of bladder tumor following the endoscopic treatment of VUR with Dx/HA in a child.


Dextranomer, Hyaluronic acid, Neuron-specific enolase, Bladder tumor

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Iva Bilić Čače,Ana Milardović,Harry Nikolić,Ana Bosak Veršić,Ivona Butorac Ahel. Could the Implantation of Dextranomer/Hyaluronic Acid Cause the Elevation of Neuron-Specific Enolase in Children Treated for Vesicoureteral Reflux?. Signa Vitae. 2020. 16(1);183-185.


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