Palmer Lane S
Division of Pediatric Urology, Schneider Children's Hospital and Smith Institute for Urology of North Shore-Long Island Jewish Health System, Long Island, New York, USA.
J Urol. 2008 Mar;179(3):1118-20; discussion 1121. doi: 10.1016/j.juro.2007.10.087. Epub 2008 Jan 18.
Dextranomer/hyaluronic acid copolymer has become a popular bulking agent for subureteral injection in the treatment of vesicoureteral reflux. The success rates are lower compared to ureteral reimplantation, and, therefore, postoperative voiding cystourethrography is required. We sought to determine if post-injection intraoperative cystography can be useful in improving the success rate of injection and replacing the need for the 3 to 4-month postoperative voiding cystourethrogram.
Dextranomer/hyaluronic acid copolymer was injected subureterally by a single surgeon until the orifice was crescentic at the dome of the bolus. Contrast material was instilled by gravity into the bladder until capacity was reached and was monitored fluoroscopically. No voiding phase was obtained. The procedure was deemed successful only in the absence of reflux. Postoperative voiding cystourethrography performed at 3 to 4 months postoperatively was used to determine whether antibiotic administration should be discontinued. The results of the 2 cystograms were compared.
A total of 41 patients (64 ureters) underwent subureteral injection. Intraoperative post-injection cystogram documented reflux eradication after a single injection in 96.9% of ureters and 95.1% of patients. Two boys had persistent reflux and 1 girl had new contralateral reflux after a single injection. In these cases additional bulking agent was injected and the reflux was confirmed by a second cystogram. There were 32 patients (52 ureters) who underwent intraoperative post-injection cystography plus postoperative voiding cystourethrography at 3 to 4 months. Postoperative voiding cystourethrography documented a 77% ureteral and 69% patient success rate. None of the patients with post-injection reflux had postoperative reflux at 3 to 4 months.
Intraoperative cystography following dextranomer/hyaluronic acid copolymer injection may help to determine immediate success and identify cases of new contralateral reflux. However, there is insufficient correlation with the standard 3 to 4-month postoperative cystogram to advocate replacing the current standard postoperative voiding cystourethrography with an intraoperative cystogram.
葡聚糖/透明质酸共聚物已成为输尿管下注射治疗膀胱输尿管反流的常用填充剂。与输尿管再植术相比，其成功率较低，因此术后需要进行排尿性膀胱尿道造影。我们试图确定注射后术中膀胱造影是否有助于提高注射成功率并取代术后3至4个月进行排尿性膀胱尿道造影的必要性。
由一名外科医生在输尿管下注射葡聚糖/透明质酸共聚物，直到在团块顶部的开口呈新月形。通过重力将造影剂注入膀胱直至达到容量，并进行荧光透视监测。未获得排尿期图像。仅在无反流的情况下该手术被视为成功。术后3至4个月进行的排尿性膀胱尿道造影用于确定是否应停止使用抗生素。比较了两次膀胱造影的结果。
共有41例患者（64条输尿管）接受了输尿管下注射。注射后术中膀胱造影显示，单次注射后96.9%的输尿管和95.1%的患者反流消除。两名男孩单次注射后仍有持续性反流，一名女孩单次注射后出现新的对侧反流。在这些病例中，额外注射了填充剂，并通过第二次膀胱造影证实了反流。有32例患者（52条输尿管）在术中注射后进行了膀胱造影，并在术后3至4个月进行了排尿性膀胱尿道造影。术后排尿性膀胱尿道造影显示输尿管成功率为77%，患者成功率为69%。注射后有反流的患者在3至4个月时均无术后反流。
葡聚糖/透明质酸共聚物注射后术中膀胱造影可能有助于确定即刻成功率，并识别新的对侧反流病例。然而，与标准的术后3至4个月膀胱造影的相关性不足，不足以主张用术中膀胱造影取代当前标准的术后排尿性膀胱尿道造影。
