Chertin Boris, Prosolovich Ksenia, Aharon Sagiv, Nativ Ofer, Halachmi Sarel
Department of Urology, Shaare Zedek Medical Center, the Faculty of Medicine Hebrew University, Jerusalem, 91031, P.O. Box 3235, Israel.
Adv Urol. 2011;2011:352716. doi: 10.1155/2011/352716. Epub 2011 Jan 9.
Purpose. In recent years, endoscopic injection became the procedure of choice for the correction of vesicoureteral reflux in the majority of the centers. Unfortunately, endoscopic treatment is not always successful and sometimes requires more than one trial to achieve similar results to that of an open reimplantation surgery. Our aim of this study is to evaluate the feasibility and success rate of open ureteral reimplantation following failed endoscopic procedure. Patients and Methods. During 2004-2010, we evaluated 16 patients with persistent vesicoureteral reflux (grades II-IV) following failed endoscopic treatment. All patients underwent open ureteral reimplantation. All patients were followed with an ultrasound 6 weeks following surgery and every 6 months thereafter for an average of 22 months. Voiding cystography was performed at 3 months after surgery. Results. During unilateral open ureteral reimplantation, the implanted deposit from previous procedures was either excised, drained, or incorporated into the neotunnel with the ureter. Vesicoureteral reflux was resolved in all patients with 100% success rate. No new hydronephrosis or signs of obstruction developed in any of the patients. qDMSA renal scan was available in 8 patients showing improvement of function in 5 and stable function in 3, and no new scars were identified. Conclusions. Open ureteral reimplantation is an excellent choice for the correction of failed endoscopic treatment in children with vesicoureteral reflux.
目的。近年来，内镜注射在大多数中心已成为纠正膀胱输尿管反流的首选方法。不幸的是，内镜治疗并非总是成功，有时需要不止一次尝试才能获得与开放再植手术相似的效果。本研究的目的是评估内镜手术失败后开放输尿管再植的可行性和成功率。患者与方法。在2004年至2010年期间，我们评估了16例内镜治疗失败后仍存在膀胱输尿管反流（Ⅱ-Ⅳ级）的患者。所有患者均接受了开放输尿管再植手术。所有患者在术后6周接受超声检查，此后每6个月检查一次，平均随访22个月。术后3个月进行排尿性膀胱尿道造影。结果。在单侧开放输尿管再植术中，将先前手术植入的沉积物切除、引流或与输尿管一起纳入新隧道。所有患者的膀胱输尿管反流均得到解决，成功率为100%。所有患者均未出现新的肾积水或梗阻迹象。8例患者进行了锝-99m二巯丁二酸（99mTc-DMSA）肾扫描，其中5例肾功能改善，3例肾功能稳定，未发现新的瘢痕。结论。对于内镜治疗失败的膀胱输尿管反流患儿，开放输尿管再植是一种很好的纠正方法。
