Puri Prem, Chertin Boris, Velayudham Murugesh, Dass Laxaman, Colhoun Eric
The National Children Hospital and Chidren's Research Centre, Our Lady's Hospital for Sick Children, University College Dublin, Ireland.
J Urol. 2003 Oct;170(4 Pt 2):1541-4; discussion 1544. doi: 10.1097/01.ju.0000083924.44779.80.
Endoscopic subureteral injection of tissue augmenting substances has become an established alternative to long-term antibiotic prophylaxis and open surgery for the management of vesicoureteral reflux (VUR) in children. Recently, dextranomer/hyaluronic acid copolymer (Deflux, Q-Med AB, Uppsala, Sweden) a biodegradable injectable material has been reported to be a promising alternative to other tissue augmenting substances. However, the experience with dextranomer/hyaluronic acid copolymer is limited. We prospectively evaluate the effectiveness of dextranomer/hyaluronic acid copolymer in the endoscopic treatment of VUR.
A total of 32 males and 81 females with a median age of 1 year (range 3 months to 10 years) underwent endoscopic correction of primary VUR with dextranomer/hyaluronic acid copolymer. Reflux was unilateral in 58 cases and bilateral in 54, affecting 166 ureters. Reflux was grades II to V in 7 (4.2%) cases, 91 (54.8%), 63 (38%) and 5 (3%), respectively. All patients underwent endoscopic correction as a day procedure and have been followed for 3 months to 1 year.
The reflux was corrected in 143 (86%) of the 166 ureters after a single injection, and resolved after a second and third injection in 22 (13%) and 1 (1%) ureter, respectively. No untoward effects were seen in any of these patients with the use of dextranomer/hyaluronic acid copolymer as an injectable material.
Dextranomer/hyaluronic acid copolymer is an effective tissue augmenting substance in the endoscopic treatment of all grades of VUR.
内镜下输尿管下注射组织增强物质已成为儿童膀胱输尿管反流（VUR）管理中替代长期抗生素预防和开放手术的既定方法。最近，葡聚糖omer/透明质酸共聚物（Deflux，Q-Med AB，瑞典乌普萨拉）一种可生物降解的可注射材料已被报道是其他组织增强物质的有前途的替代品。然而，葡聚糖omer/透明质酸共聚物的经验有限。我们前瞻性评估葡聚糖omer/透明质酸共聚物在内镜治疗VUR中的有效性。
共有32名男性和81名女性，中位年龄为1岁（范围3个月至10岁），接受了用葡聚糖omer/透明质酸共聚物进行的原发性VUR内镜矫正。反流单侧58例，双侧54例，累及166条输尿管。反流分别为II至V级的有7例（4.2%）、91例（54.8%）、63例（38%）和5例（3%）。所有患者均作为日间手术接受内镜矫正，并随访3个月至1年。
单次注射后，166条输尿管中的143条（86%）反流得到矫正，第二次和第三次注射后分别有22条（13%）和1条（1%）输尿管反流消失。使用葡聚糖omer/透明质酸共聚物作为可注射材料，这些患者均未出现不良反应。
葡聚糖omer/透明质酸共聚物是内镜治疗各级VUR的有效组织增强物质。
