Vandersteen David R, Routh Jonathan C, Kirsch Andrew J, Scherz Hal C, Ritchey Michael L, Shapiro Ellen, Wolpert James J, Pfefferle Heidi, Reinberg Yuri
Department of Urology, Children's Hospitals, Minneapolis/St. Paul, Minnesota, USA.
J Urol. 2006 Oct;176(4 Pt 1):1593-5. doi: 10.1016/j.juro.2006.06.101.
Subureteral injection of dextranomer/hyaluronic acid copolymer is widely accepted for the treatment of primary vesicoureteral reflux. Few studies document the incidence of surgically relevant postoperative obstruction or the characteristics of patients at risk.
Four institutions had reported surgically relevant postoperative obstruction to representatives of Q-Med Scandinavia, the manufacturers of Deflux (dextranomer/hyaluronic acid). All children undergoing dextranomer/hyaluronic acid injection at these institutions were evaluated in this study. Patients requiring postoperative stenting were retrospectively reviewed for pertinent history, volume injected, technique of injection, duration of symptoms before intervention, duration of intervention and final outcome.
A total of 745 patients (1,155 ureters) underwent injection. Five patients (6 renal units, 7 ureters) required stenting for obstructive symptoms and hydronephrosis, of whom 4 immediately became symptomatic. All patients had been injected with up to 1 ml dextranomer/hyaluronic acid. Four patients (80%) had either a neurogenic bladder or dysfunctional voiding. All stents were placed and removed without complications, with complete resolution of symptoms in all patients. Length of stenting ranged from 2 to 6 weeks. No patient required open surgery. One of 2 patients undergoing postoperative voiding studies had development of recurrent vesicoureteral reflux.
Dextranomer/hyaluronic acid injection is associated with a small risk of postoperative ureteral obstruction requiring endoscopic intervention, with an overall incidence of less than 0.7% of patients injected. Patients with voiding dysfunction or neurogenic bladder may be at increased risk. Intervention with temporary ureteral stenting is effective, technically simple and curative.
输尿管下注射葡聚糖凝胶/透明质酸共聚物被广泛用于治疗原发性膀胱输尿管反流。很少有研究记录手术相关的术后梗阻发生率或高危患者的特征。
四家机构已向Deflux（葡聚糖凝胶/透明质酸）制造商Q-Med斯堪的纳维亚公司的代表报告了手术相关的术后梗阻情况。本研究对这些机构中所有接受葡聚糖凝胶/透明质酸注射的儿童进行了评估。对需要术后置入支架的患者进行回顾性分析，记录其相关病史、注射量、注射技术、干预前症状持续时间、干预持续时间及最终结果。
共有745例患者（1155条输尿管）接受了注射。5例患者（6个肾单位，7条输尿管）因梗阻症状和肾积水需要置入支架，其中4例立即出现症状。所有患者注射的葡聚糖凝胶/透明质酸量均不超过1ml。4例患者（80%）患有神经源性膀胱或排尿功能障碍。所有支架的置入和取出均无并发症，所有患者症状完全缓解。支架置入时间为2至6周。无患者需要进行开放手术。2例接受术后排尿研究的患者中有1例出现复发性膀胱输尿管反流。
葡聚糖凝胶/透明质酸注射术后发生输尿管梗阻需要内镜干预的风险较小，总体发生率低于注射患者的0.7%。排尿功能障碍或神经源性膀胱患者的风险可能增加。临时输尿管支架置入干预有效、技术简单且可治愈。
