Lorenzo Armando J, Pippi Salle Joao L, Barroso Ubirajara, Cook Anthony, Grober Ethan, Wallis M Chad, Bägli Darius J, Khoury Antoine E
Division of Urology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
J Urol. 2006 Oct;176(4 Pt 2):1851-5. doi: 10.1016/S0022-5347(06)00599-4.
As the indications for endoscopic correction of vesicoureteral reflux continue to expand, the emergence of potential predictive variables has been noted. We used univariate and multivariate statistical analyses to find the most significant predictors of correction to improve patient selection.
A consecutive series of patients treated at a single institution was reviewed. Between August 1998 and August 2004, 232 children endoscopically injected with polydimethylsiloxane were identified, representing 351 refluxing units. A total of 23 variables were subjected to statistical analysis to detect predictors of reflux correction after injection. All identified patients with complete data and followup evaluations were included irrespective of anatomical variations, previous interventions or comorbidities.
The overall success rate by patient and renal unit was 65% and 72%, respectively. In patients with a single system low grade (1-3) vesicoureteral reflux who did not previously undergo injection this success rate increased to 80%. Univariate analysis demonstrated that higher physician experience, low preoperative vesicoureteral reflux grade, absent renal scars and no previous injections were statistically significant predictors of vesicoureteral reflux correction (p <0.05). A history of febrile urinary tract infections and a duplex system did not attain significance (p = 0.069 and 0.076, respectively). On multivariate statistical evaluation only physician experience, preoperative vesicoureteral reflux grade and the number of previous injections remained significant.
Multivariate analysis of our data showed the most important determinants of vesicoureteral reflux correction after endoscopic injection. Prospective validation will allow us to generate nomograms to better select and counsel patients who would benefit from vesicoureteral reflux treatment.
随着膀胱输尿管反流内镜矫正的适应证不断扩大，已注意到潜在预测变量的出现。我们采用单变量和多变量统计分析来找出矫正的最显著预测因素，以改善患者的选择。
回顾了在单一机构接受治疗的一系列连续患者。1998年8月至2004年8月期间，确定了232例接受聚二甲基硅氧烷内镜注射的儿童，代表351个反流单位。对总共23个变量进行统计分析，以检测注射后反流矫正的预测因素。所有具有完整数据和随访评估的已识别患者均被纳入，无论其解剖变异、既往干预措施或合并症如何。
按患者和肾单位计算的总体成功率分别为65%和72%。在先前未接受注射的单系统低级别（1 - 3级）膀胱输尿管反流患者中，这一成功率增至80%。单变量分析表明，医生经验更丰富、术前膀胱输尿管反流级别低、无肾瘢痕以及既往未接受注射是膀胱输尿管反流矫正的统计学显著预测因素（p <0.05）。发热性尿路感染病史和重复肾系统未达到显著水平（p分别为0.069和0.076）。多变量统计评估显示，只有医生经验、术前膀胱输尿管反流级别和既往注射次数仍然显著。
对我们的数据进行多变量分析显示了内镜注射后膀胱输尿管反流矫正的最重要决定因素。前瞻性验证将使我们能够生成列线图，以更好地选择和咨询将从膀胱输尿管反流治疗中受益的患者。
