Long-term Results of Endoscopic Deflux® Injection for Vesicoureteral Reflux in Children
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: We evaluated the long-term results of endoscopic Deflux® injection for treating vesicoureteral reflux (VUR) in children. Methods: Between September 2004 and September 2014, 243 children (137 boys and 106 girls) with a mean age of 53 months underwent Deflux® injection. Our clinical protocol included radionuclide voiding cystography (RNC) at postoperative 3 months, 1 year and 3 years to assess the VUR resolution. Results: The cure rates at 3 months, 1 year, and 3 years by patients were 70.8%, 64.3%, and 65.6% for the total patients and 79.2%, 75.2%, and 76.4%, for the ureters, respectively. The recurrence rate of postoperative febrile urinary tract infection (UTI) was 20% in patients without VUR at postoperative 1 year. Twenty patients undergoing ureteroneocystostomy (UNC) significantly had younger age (P=0.003), higher VUR grade (P<0.001), and lower success rates of Deflux® injection (P<0.05). On univariate analysis, older age (P=0.014) and lower grade of VUR (P= 0.031) were the significant predictors of a successful outcome. But there was none on multivariate analysis. Younger age, especially age of 0-12 month-old, was the only significant predictor of postoperative febrile UTI recurrence on both univariate and multivariate analysis. Conclusion: Deflux® injection is efficacious with a low complication rate for the anti-reflux procedure in children. There is low recurrence rate of UTI though VUR persists, and high probability of no VUR at 3 years if no VUR at 1 year. It is recommendable not to perform follow-up RNC at 3 years routinely if no VUR at 1 year.
Abstract
Purpose: We evaluated the long-term results of endoscopic Deflux® injection for treating vesicoureteral reflux (VUR) in children. Methods: Between September 2004 and September 2014, 243 children (137 boys and 106 girls) with a mean age of 53 months underwent Deflux® injection. Our clinical protocol included radionuclide voiding cystography (RNC) at postoperative 3 months, 1 year and 3 years to assess the VUR resolution. Results: The cure rates at 3 months, 1 year, and 3 years by patients were 70.8%, 64.3%, and 65.6% for the total patients and 79.2%, 75.2%, and 76.4%, for the ureters, respectively. The recurrence rate of postoperative febrile urinary tract infection (UTI) was 20% in patients without VUR at postoperative 1 year. Twenty patients undergoing ureteroneocystostomy (UNC) significantly had younger age (P=0.003), higher VUR grade (P<0.001), and lower success rates of Deflux® injection (P<0.05). On univariate analysis, older age (P=0.014) and lower grade of VUR (P= 0.031) were the significant predictors of a successful outcome. But there was none on multivariate analysis. Younger age, especially age of 0-12 month-old, was the only significant predictor of postoperative febrile UTI recurrence on both univariate and multivariate analysis. Conclusion: Deflux® injection is efficacious with a low complication rate for the anti-reflux procedure in children. There is low recurrence rate of UTI though VUR persists, and high probability of no VUR at 3 years if no VUR at 1 year. It is recommendable not to perform follow-up RNC at 3 years routinely if no VUR at 1 year.
참고문헌 (24)
- Smellie JM, "Medical versus surgical treatment in children with severe bilateral vesicoureteral reflux and bilateral nephropathy:a randomised trial", Lancet, 357, pp.1329~1333 (2001)
- Jacobson SH, "Vesico-ureteric reflux:occurrence and long-term risks", Acta Paediatr suppl, pp.22~30 (1999)
- Matouschek E, "Treatment of vesicorenal reflux by transurethral Teflon-injection", Urologe A, pp.263~264 (1981)
- O'Donnell B, "Treatment of vesicoureteric reflux by endoscopic injection of Teflon", J Urol, 167, pp.1808~1809 (2002)
- Dodat H, "Vesicoureteric reflux in children: long-term results of endoscopic treatment by Macroplastique injection", Prog Urol, 14, pp.380~384 (2004)
- Kirsch AJ, "The modified sting procedure to correct vesicoureteral reflux : improved results with submucosal implantation within the intramural ureter", J Urol, 171, pp.2413~2416 (2004)
- van Capelle JW1, "The longterm outcome of the endoscopic subureteric implantation of polydimethylsiloxane for treating vesico-ureteric reflux in children : a retrospective analysis of the first 195 consecutive patients in two European centres", BJU Int, 94, pp.1348~1351 (2004)
- Stenberg A, "A new bioimplant for the endoscopic treatment of vesicoureteral reflux : experimental and short-term clinical results", J Urol, 154, pp.800~803 (1995)
- Puri P, "Treatment of vesicoureteral reflux by endoscopic injection of dextranomer", hyaluronic acid copolymer(Deflux) : preliminary results, 2003, pp.170, 1541~1544
- Chertin B, "Endoscopic treatment of vesicoureteral reflux : 11 to 17 years of followup", J Urol, 167, pp.1443~1446 (2002)
- Routh JC, "Single center experience with endoscopic management of vesicoureteral reflux in children", J Urol, 175, pp.1889~1892 (2006)
- 박용현, "방광요관역류 환아에서 Dextranomer", hyaluronic Acid Copolymer(Deflux？) 주사요법의 효과 및 안전성에 대한 고찰, 2007, pp.48(6), 620~626[DOI]
- Capozza N, "Dextranomer", hyaluronic acid copolymer implantation for vesico-ureteral reflux : a randomized comparison with antibiotic prophylaxis, 2002, pp.140, 230~234
- Elder JS, "Endoscopic therapy for vesicoureteral reflux: a metaanalysis. I. Reflux resolution and urinary tract infection", J Urol, 175, pp.716~722 (2006)
- Puri P, "Treatment of vesicoureteral reflux by endoscopic injection of dextranomer", hyaluronic acid copolymer : preliminary results, 2003, pp.170, 1541~1544
- Al-Hunayan AA, "Outcome of endoscopic treatment for vesicoureteral reflux in children using polydimethylsiloxane", J Urol, 168, pp.2181~2183 (2002)
- Läckgren G, "Long-term followup of children treated with dextranomer", hyaluronic acid copolymer for vesicoureteral reflux, 2001, pp.166, 1887~1892
- Lee EK, "Long-term followup of dextranomer", hyaluronic acid injection for vesicoureteral reflux : late failure warrants continued follow-up, 2009, pp.181, 1869~1874
- Schmedding A, "Sx INprospective multicenter survey of subureteral injection in children", Presented at International Conference on VUR in Children (2009)
- Puri P, "Single center experience with endoscopic subureteral dextranomer", hyaluronic Acid injection as first line treatment in 1,551 children with intermediate and high grade vesicoureteral reflux, 2012, pp.188(4 Suppl), 1485~1489
- Kajbafzadeh A, "Factors that impact the outcome of endoscopic correction of vesicoureteral reflux : a multivariate analysis", Int Urol Nephrol, 45, pp.1~9 (2013)
- Stredele RJF, "Long-term results of endoscopic treatment of vesicoureteral reflux in children : Comparison of different bulking agents", J Pediatr Urol, 9, pp.71~77 (2013)
- 백민기, "Clinical Value of Persistent but Downgraded Vesicoureteral Reflux after Dextranomer", Hyaluronic Acid Injection in Children, 2013, pp.28(7), 1060~1064[DOI]
- Keren R, "Rationale and Design Issues of the Randomized Intervention for Children With Vesicoureteral Reflux", Study Pediatrics, 122, pp.240~250 (2008)