Elmore James M, Kirsch Andrew J, Heiss Erik A, Gilchrist Alienor, Scherz Hal C
Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA.
J Urol. 2008 Jun;179(6):2364-7; discussion 2367-8. doi: 10.1016/j.juro.2008.01.149. Epub 2008 Apr 23.
Endoscopic implantation of dextranomer/hyaluronic acid has proved to be an effective minimally invasive technique for correcting vesicoureteral reflux in children. There is some evidence suggesting that in addition to being less invasive, successful dextranomer/hyaluronic acid implantation compared to successful antireflux surgery is associated with fewer febrile and nonfebrile urinary tract infections. We review the clinical outcomes of 2 groups of children cured of reflux with open surgery and dextranomer/hyaluronic acid implantation to determine if a difference in clinical outcomes exists.
We reviewed the charts of 43 patients who underwent dextranomer/hyaluronic acid implantation and 33 who underwent open surgery for vesicoureteral reflux. Data collected included age, gender, preoperative and postoperative grades of reflux, and urinalysis and urine culture results. Urinary tract infection was defined as any culture that grew more than 10(5) colonies of a single organism, with symptoms typical of cystitis (urgency, frequency, dysuria). A febrile urinary tract infection was defined as an infection accompanied by a temperature greater than 101.5F. Any hospitalizations for febrile episodes were also recorded.
The incidence of urinary tract infection after successful open surgery (38%) was significantly higher than that observed following successful dextranomer/hyaluronic acid treatment (15%, p = 0.03). Febrile urinary tract infections occurred in 24% of the children who underwent open surgery and in 5% of those who underwent dextranomer/hyaluronic acid implantation (p = 0.02). Hospital readmissions occurred only in the group undergoing open surgery.
Children successfully cured of vesicoureteral reflux with dextranomer/hyaluronic acid implantation have a lower incidence of febrile and nonfebrile urinary tract infections compared to those cured with open surgery. These findings suggest that dextranomer/hyaluronic acid implantation, when successful, may result in more favorable clinical outcomes.
已证明内镜下植入葡聚糖凝胶/透明质酸是一种治疗儿童膀胱输尿管反流的有效微创技术。有证据表明，与成功的抗反流手术相比，成功植入葡聚糖凝胶/透明质酸不仅侵入性更小，而且与发热性和非发热性尿路感染的发生率较低相关。我们回顾两组分别通过开放手术和植入葡聚糖凝胶/透明质酸治愈反流的儿童的临床结果，以确定临床结果是否存在差异。
我们回顾了43例行葡聚糖凝胶/透明质酸植入术和33例行膀胱输尿管反流开放手术患者的病历。收集的数据包括年龄、性别、术前和术后反流分级以及尿液分析和尿培养结果。尿路感染定义为任何培养出超过10⁵个单一生物体菌落且伴有膀胱炎典型症状（尿急、尿频、尿痛）的培养。发热性尿路感染定义为伴有体温高于101.5°F的感染。还记录了因发热发作而住院的情况。
成功的开放手术后尿路感染发生率（38%）显著高于成功的葡聚糖凝胶/透明质酸治疗后（15%，p = 0.03）。接受开放手术的儿童中有24%发生发热性尿路感染，接受葡聚糖凝胶/透明质酸植入术的儿童中有5%发生（p = 0.02）。再次住院仅发生在接受开放手术的组中。
与通过开放手术治愈的儿童相比，通过植入葡聚糖凝胶/透明质酸成功治愈膀胱输尿管反流的儿童发热性和非发热性尿路感染的发生率较低。这些发现表明，成功植入葡聚糖凝胶/透明质酸可能会带来更有利的临床结果。
