Inoue K, Nakamoto T, Usui A, Usui T
Department of Urology, Hiroshima University School of Medicine, Hiroshima City, Hiroshima, Japan.
J Urol. 2000 Aug;164(2):336-9.
We assessed the effectiveness of endoscopic subureteral glutaraldehyde cross-linked collagen injection for treating vesicoureteral reflux in patients with vesicoureteral disorders.
All 51 ureters studied had grade II or greater vesicoureteral reflux. We treated 18 patients (24 refluxing ureters) with secondary and 17 adults (27 refluxing ureters) with primary vesicoureteral reflux. The primary group served as controls to establish normal urination. A total of 14 patients with secondary vesicoureteral reflux had a low compliant autonomous bladder, including 11 with myelodysplasia and 3 after pelvic surgery and radiotherapy. One patient had an unstable bladder due to cerebral palsy and 3 had anatomical abnormalities of the urinary tract. We evaluated the estimated reflux-free rate in the secondary and adult primary vesicoureteral reflux groups.
Repeat injection was required in 24 ureters because of recurrent reflux. Average injected volume in the secondary and primary groups was 2.72 and 2.88 ml. per refluxing unit, respectively. The estimated reflux-free rate after the initial injection decreased gradually to about 35% in each group, while 12 and 24 months after the last injection it remained constant at 70% in the secondary group but decreased from 84.7% to 62.1% in the primary group. The percent of late recurrence was higher in the primary group.
Long-term efficacy of the endoscopic correction of vesicoureteral reflux in the secondary group was similar to that in the primary group. Thus, endoscopic subureteral glutaraldehyde cross-linked collagen injection is useful for treating complicated secondary vesicoureteral reflux as a minimally invasive procedure. It is considered optional treatment of primary vesicoureteral reflux to avoid long-term prophylactic treatment.
我们评估了内镜下输尿管下注射戊二醛交联胶原蛋白治疗膀胱输尿管反流性疾病患者膀胱输尿管反流的有效性。
所研究的51条输尿管均有II级或以上膀胱输尿管反流。我们治疗了18例继发性膀胱输尿管反流患者（24条反流输尿管）和17例原发性膀胱输尿管反流成人患者（27条反流输尿管）。原发性组作为对照组以建立正常排尿。14例继发性膀胱输尿管反流患者存在低顺应性自主性膀胱，其中11例患有脊髓发育不良，3例在盆腔手术和放疗后出现。1例患者因脑瘫导致膀胱不稳定，3例存在泌尿系统解剖异常。我们评估了继发性和成人原发性膀胱输尿管反流组的估计无反流率。
24条输尿管因反流复发需要重复注射。继发性组和原发性组的平均注射量分别为每个反流单位2.72毫升和2.88毫升。初次注射后的估计无反流率在每组中逐渐降至约35%，而在最后一次注射后12个月和24个月时，继发性组保持在70%不变，而原发性组从84.7%降至62.1%。原发性组的晚期复发率更高。
继发性组内镜矫正膀胱输尿管反流的长期疗效与原发性组相似。因此，内镜下输尿管下注射戊二醛交联胶原蛋白作为一种微创手术，可用于治疗复杂的继发性膀胱输尿管反流。它被认为是原发性膀胱输尿管反流的可选治疗方法，以避免长期预防性治疗。
