Ozok Ugur, Eroglu Muzaffer, Imamoglu Abdurrahim, Bakirtaş Hasan, Güvence Necmettin, Kiper Ahmet
Department of Urology, SSK Ihtisas Hospital, Ankara, Turkey.
J Endourol. 2005 Dec;19(10):1185-7. doi: 10.1089/end.2005.19.1185.
Endoscopic subureteral injection of tissue-augmenting substances has become an alternative to antibiotic prophylaxis and open surgery for the management of vesicoureteral reflux (VUR). Several injectable materials have been tried for this purpose. In this study, we tried to determine the efficacy of dextranomer/hyaluronic acid copolymer (Dx/HA) injection for the treatment of VUR in renal-transplant candidates.
A total of 21 transplant candidates (29 ureteral units; 13 females, 8 males) with a mean age of 20.2 years (range 14-26 years) underwent endoscopic correction of VUR with Dx/HA. Diagnosis of VUR was made by voiding cystourethrography. The efficacy of the treatment was assessed with voiding cystourethrography at 3 months and 1 year postoperatively. Renal transplantation with living related donor organs was performed in 11 of the 21 patients.
Endoscopic treatment was performed without complication in all cases. Higher success rates were obtained in patients with low-grade reflux, the overall success rate in the series being 82.7%. The mean follow- up after renal transplantation was 21.8 months (range 5-45 months). In one patient, reflux recurred after renal transplantation and was treated successfully by a repeat Dx/HA injection. The urine cultures of all patients remained sterile.
Transplant candidates with VUR can be treated with Dx/HA, which cured the majority of our patients after one or two treatments with few low side effects. Endoscopic subureteral injection of Dx/HA has become an alternative treatment for VUR in transplant candidates. Long-term results are needed before making a final statement about its value.
内镜下输尿管下注射组织增强物质已成为抗生素预防和开放手术治疗膀胱输尿管反流（VUR）的替代方法。为此已尝试了几种可注射材料。在本研究中，我们试图确定葡聚糖omer/透明质酸共聚物（Dx/HA）注射治疗肾移植候选者VUR的疗效。
共有21例移植候选者（29个输尿管单位；13例女性，8例男性），平均年龄20.2岁（范围14 - 26岁），接受了Dx/HA内镜下VUR矫正术。VUR的诊断通过排尿性膀胱尿道造影进行。术后3个月和1年通过排尿性膀胱尿道造影评估治疗效果。21例患者中有11例接受了亲属活体供肾肾移植。
所有病例内镜治疗均无并发症。低度反流患者成功率更高，该系列总体成功率为82.7%。肾移植后的平均随访时间为21.8个月（范围5 - 45个月）。1例患者肾移植后反流复发，通过重复Dx/HA注射成功治疗。所有患者的尿培养均无菌。
VUR移植候选者可用Dx/HA治疗，大多数患者经一两次治疗后治愈，副作用少。内镜下输尿管下注射Dx/HA已成为移植候选者VUR的替代治疗方法。在对其价值做出最终评价之前，需要长期结果。
