Somoza I, Vela D, Liras J, Méndez R, Tellado M G, Abuín A S, Ríos J, Bueno J, Pais E
Servicio de Cirugía Pediátrica, Hospital Materno Infantil Teresa Herrera, Complexo Hospitalario Juan Canalejo, A Coruña.
Cir Pediatr. 2003 Apr;16(2):90-4.
Endoscopic management has become an important alternative in the treatment of vesicoureteral reflux in children. Since 1995 we indicate it in our Hospital in children with grade II VUR (vesicoureteral reflux) after 1 year of medical management, in all children with grade III VUR and in children with grade IV VUR without reflux nephropathy. According to International Classification of reflux (IRSC), grade IV VUR differ to grade III mainly by the blunting of the calyces and the obliteration of sharp angle of the fornices. There may be seen in the high grades of reflux, important differences in the ureteral dilatation.
The aim of this work is to study the influence of ureteral dilatation in the success of endoscopic management VUR.
A number of 245 refluxing renal units (URR) were treated endoscopically in our Hospital from 1995. We review the first 3.5 years (58 patients with 90 RRU). In a double blind study with the voiding cystourethrographies we graduated the ureteral dilatation in slight-normal, moderate and severe. The success rate after the first injection was compared between the 3 grades of ureteral dilatation.
3 patients had grade I VUR, 10 grade II, 54 grade III and 23 grade IV. After double blind study 39 patients had slight-normal ureteral dilatation, 39 moderate and 12 severe. There were statistical differences between the 3 grades of ureteral dilatation when we consider: all the patients, considering only grade III and IV reflux and studying only the patients with grade III reflux. However there wasn't statistical differences between grade III and IV VUR of the International Classification.
The results show that ureteral dilatation is an important prognostical factor of the success rate in the endoscopic management of vesicoureteral reflux in children.
内镜治疗已成为儿童膀胱输尿管反流治疗的重要替代方法。自1995年以来，我们医院对经1年药物治疗后的II级膀胱输尿管反流（VUR）患儿、所有III级VUR患儿以及无反流性肾病的IV级VUR患儿采用该方法治疗。根据国际反流分类（IRSC），IV级VUR与III级的主要区别在于肾盏变钝和穹窿锐角消失。在高度反流中，输尿管扩张可能存在显著差异。
本研究旨在探讨输尿管扩张对内镜治疗VUR成功率的影响。
1995年起我院对245个反流性肾单位（URR）进行了内镜治疗。我们回顾了前3.5年（58例患者，90个RRU）的情况。在一项关于排尿性膀胱尿道造影的双盲研究中，我们将输尿管扩张程度分为轻度-正常、中度和重度。比较了输尿管扩张3个等级首次注射后的成功率。
3例患者为I级VUR，10例为II级，54例为III级，23例为IV级。双盲研究后，39例患者输尿管扩张为轻度-正常，39例为中度，12例为重度。在考虑所有患者、仅考虑III级和IV级反流以及仅研究III级反流患者时，输尿管扩张的3个等级之间存在统计学差异。然而，国际分类中的III级和IV级VUR之间没有统计学差异。
结果表明，输尿管扩张是儿童膀胱输尿管反流内镜治疗成功率的重要预后因素。
