Läckgren G, Wåhlin N, Sköldenberg E, Stenberg A
Section of Urology, University Children's Hospital, Uppsala, Sweden.
J Urol. 2001 Nov;166(5):1887-92. doi: 10.1016/s0022-5347(05)65713-8.
Dextranomer/hyaluronic acid copolymer is a novel substance that has favorable properties for endoscopic treatment of vesicoureteral reflux. We assess the long-term efficacy and safety of this treatment of children.
Children 1 to 15 years old with grade III or greater vesicoureteral reflux were eligible for enrollment in our study. All patients received endoscopic treatment with dextranomer/hyaluronic acid copolymer and were scheduled to have a voiding cystourethrogram 3 and 12 months after implantation. Children with reflux grade III or greater after treatment received up to 2 more implantations, and those with persistent reflux were referred for open surgery. In some cases long-term clinical followup was accompanied by a late voiding cystourethrogram.
A total of 228 patients received endoscopic treatment. The efficacy population was comprised of 221 children, including 67 who received 2 and 8 who received 3 implantations. Endoscopic treatment was performed without complications in all cases. Patients were followed clinically for 2 to 7.5 years (mean 5). On the last voiding cystourethrogram 68% of patients had a positive response (grade I or less) and 81% had no dilating reflux. The corresponding results for treated ureters were 75% and 85%, respectively. Only 27 (12%) patients were referred for open surgery. A late voiding cystourethrogram was performed in 49 patients 2 to 5 years after treatment. Of the ureters free of reflux (grade 0) 3 to 12 months after treatment 96% remained free of dilating reflux. Adverse events occurred in association with implantation in only 2% of patients, although urinary tract infection subsequently developed in 8%.
Endoscopic treatment with dextranomer/hyaluronic acid copolymer was effective and well tolerated in children with vesicoureteral reflux. Long-term followup indicated that there was no deterioration in patients responding positively to treatment.
葡聚糖凝胶/透明质酸共聚物是一种新型物质，在内镜下治疗膀胱输尿管反流方面具有良好特性。我们评估了这种治疗方法对儿童的长期疗效和安全性。
年龄在1至15岁、膀胱输尿管反流分级为III级或更高的儿童符合本研究入组条件。所有患者均接受了葡聚糖凝胶/透明质酸共聚物的内镜治疗，并计划在植入后3个月和12个月进行排尿性膀胱尿道造影。治疗后反流分级为III级或更高的儿童最多可再接受2次植入，而持续性反流的儿童则被转至开放手术治疗。在某些情况下，长期临床随访伴有晚期排尿性膀胱尿道造影。
共有228例患者接受了内镜治疗。有效人群包括221名儿童，其中67名接受了2次植入，8名接受了3次植入。所有病例的内镜治疗均无并发症。对患者进行了2至7.5年（平均5年）的临床随访。在最后一次排尿性膀胱尿道造影中，68%的患者有阳性反应（I级或更低），81%没有扩张性反流。治疗输尿管的相应结果分别为75%和85%。只有27例（12%）患者被转至开放手术治疗。49例患者在治疗后2至5年进行了晚期排尿性膀胱尿道造影。治疗后3至12个月无反流（0级）的输尿管中，96%仍无扩张性反流。仅2%的患者在植入时出现不良事件，不过随后有8%的患者发生了尿路感染。
葡聚糖凝胶/透明质酸共聚物的内镜治疗对膀胱输尿管反流儿童有效且耐受性良好。长期随访表明，对治疗有阳性反应的患者病情没有恶化。
