Lavine M A, Siddiq F M, Cahn D J, Caesar R E, Koyle M A, Caldamone A A
Hasbro Children's Hospital, Brown University, Division of Urology, School of Medicine, Providence, Rhode Island, USA.
Tech Urol. 2001 Mar;7(1):50-4.
The aim of this study was to determine the risk factors for vesicoureteral reflux following ureteral reimplantation to identify a population that can be safely excluded from postoperative voiding cystography.
We retrospectively reviewed the medical records of 273 patients who underwent ureteroneocystostomy for vesicoureteral reflux between 1990 and 1998 and recorded the postoperative renal ultrasonography and voiding cystography results.
There were 273 patients (534 ureters) who underwent ureteral reimplantation. We recorded the grade of preoperative hydronephrosis and vesicoureteral reflux and noted several preoperative and intraoperative variables, such as dysfunctional voiding, breakthrough infections, renal scarring, bladder trabeculations, type of reimplant, and postoperative urinary tract infections. With a mean follow-up of 20.6 months, persistent postoperative vesicoureteral reflux was noted in 11 patients (4%). Persistent postoperative reflux was noted in 11 patients (4%) or 12 renal units (2.2%). Reflux resolution rates for 534 renal units and 273 patients after routine follow-up voiding cystourethrogram (VCUG) was 97.8% (renal units) and 96% (patients), respectively. Contralateral vesicoureteral reflux developed in 4 (5.1%) of the 78 patients who underwent unilateral reimplantation. Two patients (0.7%) had postoperative ureteral obstruction. The risk factors for persistent postoperative reflux were identified as preoperative and postoperative hydronephrosis, renal scarring, and tapered reimplantations. The type of reimplant did not correlate with outcome.
Vesicoureteral reflux after ureteral reimplantation is uncommon (4%). Because of the high success rate of ureteral reimplants and the benign course of those patients with persistent low-grade postoperative reflux, it is safe and efficient to eliminate postoperative VCUG in most patients who had a simple ureteral reimplantation for reflux. However, in some higher-risk patients, such as those with preoperative hydronephrosis, renal scarring, and ureteral tapering, postoperative voiding cystography may be indicated to assure resolution of vesicoureteral reflux.
本研究的目的是确定输尿管再植术后膀胱输尿管反流的危险因素，以识别可安全免除术后排尿性膀胱尿道造影的人群。
我们回顾性分析了1990年至1998年间因膀胱输尿管反流接受输尿管膀胱吻合术的273例患者的病历，并记录了术后肾脏超声检查和排尿性膀胱尿道造影结果。
有273例患者（534条输尿管）接受了输尿管再植术。我们记录了术前肾积水和膀胱输尿管反流的分级，并记录了一些术前和术中变量，如排尿功能障碍、突破性感染、肾瘢痕形成、膀胱小梁形成、再植类型和术后尿路感染。平均随访20.6个月，11例患者（4%）出现持续性术后膀胱输尿管反流。11例患者（4%）或12个肾单位（2.2%）出现持续性术后反流。534个肾单位和273例患者在常规随访排尿性膀胱尿道造影（VCUG）后的反流消失率分别为97.8%（肾单位）和96%（患者）。78例接受单侧再植术的患者中有4例（5.1%）发生对侧膀胱输尿管反流。2例患者（0.7%）出现术后输尿管梗阻。持续性术后反流的危险因素被确定为术前和术后肾积水、肾瘢痕形成和锥形再植。再植类型与结果无关。
输尿管再植术后膀胱输尿管反流并不常见（4%）。由于输尿管再植成功率高，且持续性低度术后反流患者病程良性，对于大多数因反流接受简单输尿管再植术的患者，免除术后VCUG是安全有效的。然而，在一些高危患者中，如术前有肾积水、肾瘢痕形成和输尿管变细的患者，可能需要进行术后排尿性膀胱尿道造影以确保膀胱输尿管反流消失。
