Schwentner C, Oswald J, Lunacek A, Deibl M, Koerner I, Bartsch G, Radmayr Christian
Department of Pediatric Urology, Medical University, Innsbruck, Austria.
Eur Urol. 2006 Feb;49(2):388-95. doi: 10.1016/j.eururo.2005.11.015. Epub 2005 Dec 20.
There is a consensus that transvesical reimplantation is more appropriate in cases of bilateral vesicoureteral reflex (VUR). In contrast to that it is not yet clear which approach should be used in unilateral VUR. This prospective, randomized trial compared the benefits and drawbacks of the intravesical and extravesical techniques in terms of operative comorbidity.
Forty-four children (29 girls, 15 boys, mean age, 67.23 mo) with unilateral VUR were assigned to two groups: 22 patients underwent Lich-Gregoir reimplantation and 22 underwent the intravesical Politano-Leadbetter technique. Follow-up evaluation included renal ultrasonography and voiding cystourethrography (VCUG) 6 mo postoperatively. The groups were compared for operative time, duration of hematuria, upper tract dilation, discomfort and pain, analgesic requirements, voiding dysfunction, and reflux persistency.
No child had persistent VUR. Contralateral degrees II VUR was noted in five patients without significant difference regarding the treatment (p = 0.345). It was transient in all cases. Operative time was shorter using the extravesical technique (66.73 min versus 79.28 min; p < 0.0001). Gross hematuria occurred only after intravesical reimplantation lasting 4.19 d (p < 0.00001). The objective pain score was worse after intravesical surgery (p = 0.002). Analgesic requirements were higher after the Politano reimplantation (p = 0.039).
Both unilateral extravesical and intravesical reimplantation definitively correct VUR. The mean operative time was significantly shorter using the Lich-Gregoir technique, which underlines its simplicity; additionally, gross hematuria can be avoided. Postoperative pain and bladder spasms were reduced using the extravesical approach. Consequently, it represents an effective surgical technique to correct reflux while operative morbidity is low. Therefore it is the method of choice in cases of unilateral VUR requiring correction.
对于双侧膀胱输尿管反流（VUR）病例，经膀胱再植术更为合适，这一点已达成共识。相比之下，对于单侧VUR应采用哪种方法尚不清楚。这项前瞻性随机试验比较了膀胱内和膀胱外技术在手术合并症方面的利弊。
44例单侧VUR患儿（29例女孩，15例男孩，平均年龄67.23个月）被分为两组：22例患者接受了利奇-格雷戈尔再植术，22例接受了膀胱内波利塔诺-利德贝特技术。随访评估包括术后6个月的肾脏超声检查和排尿性膀胱尿道造影（VCUG）。比较两组的手术时间、血尿持续时间、上尿路扩张、不适与疼痛、镇痛需求、排尿功能障碍和反流持续情况。
无患儿存在持续性VUR。5例患者出现对侧II度VUR，治疗方面无显著差异（p = 0.345）。所有病例均为暂时性。膀胱外技术的手术时间较短（66.73分钟对79.28分钟；p < 0.0001）。肉眼血尿仅在膀胱内再植术后出现，持续4.19天（p < 0.00001）。膀胱内手术后客观疼痛评分更差（p = 0.002）。波利塔诺再植术后镇痛需求更高（p = 0.039）。
单侧膀胱外和膀胱内再植术均能明确纠正VUR。使用利奇-格雷戈尔技术平均手术时间显著更短，突出了其简便性；此外，可避免肉眼血尿。膀胱外方法可减轻术后疼痛和膀胱痉挛。因此，它是一种在纠正反流时手术合并症低的有效手术技术。所以它是需要纠正的单侧VUR病例的首选方法。
