Lavelle Michael T, Conlin Michael J, Skoog Steven J
Oregon Health Sciences University, Portland, Oregon 97239-3098, USA.
Urology. 2005 Mar;65(3):564-7. doi: 10.1016/j.urology.2004.09.068.
To review, prospectively, our experience with endoscopic Deflux injection and evaluate the volume injected, grade, endoscopic appearance after injection, and presence or absence of voiding dysfunction as predictors of success. Subureteral injection of dextranomer/hyaluronic acid copolymer (Deflux) has become an effective treatment of vesicoureteral reflux.
A total of 52 patients (50 females and 2 males; 80 ureters) were treated with a single subureteral injection of Deflux. The mean patient age was 7.6 years (range 14 months to 22 years). The presence or absence of voiding dysfunction was evaluated with a preoperative questionnaire and patient history. The volume of Deflux injected in each ureter was recorded. The endoscopic appearance after injection was recorded as "volcano" or "other." Success was defined as no reflux on postoperative voiding cystourethrography.
The success rate by grade of reflux in individual ureters was 82%, 84%, 78%, and 73% for grade 1, 2, 3, and 4 vesicoureteral reflux, respectively. No statistically significant difference was found in the cure rate by grade (P = 0.76). The overall cure rate by ureter was 80% and by patient was 71%. New contralateral reflux developed in 12.5% of patients. No statistically significant difference was found in the cure rate with respect to the volume injected or the presence or absence of voiding dysfunction. The ureteral cure rate with volcano and alternate morphology was 87% and 53%, respectively (P = 0.004).
Mound morphology was the only statistically significant predictor of a successful outcome, with an associated cure rate of 87%. Concomitant voiding dysfunction did not have an adverse effect on the cure rate. In our experience, no statistically significant difference was found in the cure rate for grades 1 through 4 vesicoureteral reflux after a single injection of Deflux.
前瞻性地回顾我们在内镜下注射Deflux的经验，并评估注射量、分级、注射后的内镜表现以及是否存在排尿功能障碍作为成功预测指标。输尿管下注射葡聚糖omer/透明质酸共聚物（Deflux）已成为治疗膀胱输尿管反流的有效方法。
共有52例患者（50例女性和2例男性；80条输尿管）接受了单次输尿管下注射Deflux治疗。患者平均年龄为7.6岁（范围为14个月至22岁）。通过术前问卷和患者病史评估是否存在排尿功能障碍。记录每条输尿管注射的Deflux量。注射后的内镜表现记录为“火山”或“其他”。成功定义为术后排尿膀胱尿道造影无反流。
1级、2级、3级和4级膀胱输尿管反流的单个输尿管反流分级成功率分别为82%、84%、78%和73%。分级治愈率无统计学显著差异（P = 0.76）。按输尿管计算的总体治愈率为80%，按患者计算为71%。12.5%的患者出现新的对侧反流。注射量或是否存在排尿功能障碍对治愈率无统计学显著差异。火山形态和其他形态的输尿管治愈率分别为87%和53%（P = 0.004）。
丘状形态是成功结果的唯一统计学显著预测指标，相关治愈率为87%。同时存在的排尿功能障碍对治愈率没有不利影响。根据我们的经验，单次注射Deflux后1至4级膀胱输尿管反流的治愈率无统计学显著差异。
