Bar-Yosef Yuval, Binyamini Joseph, Sofer Mario, Matzkin Haim, Ben-Chaim Jacob
Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University.
Harefuah. 2005 Sep;144(9):613-5, 679, 678.
Endoscopic injection is a minimal invasive treatment for vesico-ureteral reflux, an alternative for prophylactic antibiotics or open surgery. Concerns of safety were raised regarding traditional injectable materials used in the past. The recently introduced dextranomer/hyaluronic acid is a new biocompatable substance. Its safety and efficacy has been investigated and demonstrated.
To report our preliminary results with the endoscopic injection of dextranomer/hyaluronic acid.
Twenty nine pediatric patients of mean age 58 months (range 6-144) underwent endoscopic treatment. A total of 42 refluxing ureteral units were treated. Reflux grade was 2, 3, and 4 in 10, 24, and 8, respectively. The procedure was performed under general anesthesia, using a 9.5FR pediatric cystoscope and a semi-rigid needle. The substance was injected submucosally at the 6-o'clock position of the ureteral orifice. A mean of 0.87 ml of the substance was injected (range: 0.6-1.2). In the latter part of the series we injected a minimum of 1 ml for each ureter. During follow-up, ultrasonography and a voiding cystography were performed after 1 and 3 months respectively.
Vesico-ureteral reflux resolved in 32/42 (76%) of the ureters. The rate of success was 10/10 (100%), 19/24 (79%) and 4/8 (50%) in reflux grades 2, 3, and 4, respectively. De-novo contralateral reflux was noted in 5 patients. A single complication occurred: acute venous bleeding originating in the injection site, which was managed endoscopically.
Endoscopic injection of dextranomer/ hyaluronic acid is a safe and effective treatment. We recommend the injection of 1 ml, the entire volume available for each ureter.
内镜注射是治疗膀胱输尿管反流的一种微创治疗方法，可替代预防性抗生素治疗或开放手术。过去使用的传统注射材料引发了对安全性的担忧。最近引入的葡聚糖omer/透明质酸是一种新型生物相容性物质。其安全性和有效性已得到研究和证实。
报告我们内镜注射葡聚糖omer/透明质酸的初步结果。
29例平均年龄58个月（范围6 - 144个月）的儿科患者接受了内镜治疗。共治疗了42个反流性输尿管单位。反流分级为2级、3级和4级的分别有10个、24个和8个。手术在全身麻醉下进行，使用9.5FR小儿膀胱镜和半刚性针。在输尿管口6点钟位置黏膜下注射该物质。平均注射该物质0.87ml（范围：0.6 - 1.2ml）。在该系列研究的后期，我们为每个输尿管至少注射1ml。随访期间，分别在1个月和3个月后进行超声检查和排尿性膀胱尿道造影。
42个输尿管中有32个（76%）的膀胱输尿管反流得到解决。反流2级、3级和4级的成功率分别为10/10（100%）、19/24（79%）和4/8（50%）。5例患者出现新发对侧反流。发生了1例并发症：注射部位急性静脉出血，通过内镜进行了处理。
内镜注射葡聚糖omer/透明质酸是一种安全有效的治疗方法。我们建议为每个输尿管注射1ml，即每个输尿管可用的全部剂量。
