Routh Jonathan C, Reinberg Yuri, Ashley Richard A, Inman Brant A, Wolpert James J, Vandersteen David R, Husmann Douglas A, Kramer Stephen A
Department of Urology, Mayo Clinic, Rochester, Minneapolis, Minnesota 55901, USA.
J Urol. 2007 Oct;178(4 Pt 2):1702-5; discussion 1705-6. doi: 10.1016/j.juro.2007.03.174. Epub 2007 Aug 17.
Numerous factors have been postulated to increase success rates for dextranomer/hyaluronic acid injection for vesicoureteral reflux. Ureteral hydrodistention combined with intraureteral injection reportedly improves injection success rates. We combined the results of 5 pediatric urologists to evaluate the efficacy of this technique compared to that of subtrigonal-only injection in relation to other factors.
Patients with primary vesicoureteral reflux undergoing dextranomer/hyaluronic acid injection from April 2002 to December 2005 at 2 institutions were eligible. Only patients with primary vesicoureteral reflux were included in the study. Injection success was defined as the complete absence of reflux on followup voiding cystourethrogram or radionuclide cystogram. Predictors of a successful outcome were analyzed statistically with logistic regression. Factors included in our analysis were gender, age, vesicoureteral reflux grade, dysfunctional voiding, amount of injected dextranomer/hyaluronic acid, injection technique (intraureteral vs subureteral) and surgeon.
A total of 301 patients (453 ureters) with a median age of 5.5 years met inclusion criteria, of whom 199 (66%) were cured at 3 months of followup. Of the patients 145 (48%) underwent subureteral injection and 156 (52%) underwent ureteral hydrodistention combined with intraureteral injection. On multivariate analysis only vesicoureteral reflux grade (p <0.001) and surgeon (p = 0.01) were significantly predictive of injection success. There was a trend toward significance with ureteral hydrodistention combined with intraureteral injection (p = 0.056).
In our multivariate model only vesicoureteral reflux grade and surgeon were independently predictive of injection success in patients with primary, uncomplicated vesicoureteral reflux. There was a trend toward improved results with ureteral hydrodistention combined with intraureteral injection, although this did not achieve statistical significance.
已有多种因素被假定可提高葡聚糖凝胶/透明质酸注射治疗膀胱输尿管反流的成功率。据报道，输尿管水扩张联合输尿管内注射可提高注射成功率。我们汇总了5位小儿泌尿科医生的结果，以评估与仅三角区下注射相比，该技术联合其他因素的疗效。
2002年4月至2005年12月在2家机构接受葡聚糖凝胶/透明质酸注射的原发性膀胱输尿管反流患者符合入选标准。本研究仅纳入原发性膀胱输尿管反流患者。注射成功定义为随访排尿膀胱尿道造影或放射性核素膀胱造影时反流完全消失。采用逻辑回归对成功结果的预测因素进行统计学分析。我们分析的因素包括性别、年龄、膀胱输尿管反流分级、排尿功能障碍、注射的葡聚糖凝胶/透明质酸量、注射技术（输尿管内注射与输尿管下注射）和外科医生。
共有301例患者（453条输尿管）符合入选标准，中位年龄为5.5岁，其中199例（66%）在随访3个月时治愈。145例患者（48%）接受输尿管下注射，156例患者（52%）接受输尿管水扩张联合输尿管内注射。多因素分析显示，仅膀胱输尿管反流分级（p<0.001）和外科医生（p=0.01）对注射成功有显著预测作用。输尿管水扩张联合输尿管内注射有显著趋势（p=0.056）。
在我们的多因素模型中，仅膀胱输尿管反流分级和外科医生可独立预测原发性、非复杂性膀胱输尿管反流患者注射成功。输尿管水扩张联合输尿管内注射虽未达到统计学意义，但有改善结果的趋势。
