Division of Urology, Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Québec, Canada.
Urology. 2011 Jun;77(6):1284-7. doi: 10.1016/j.urology.2010.12.080. Epub 2011 Apr 15.
To prospectively evaluate the efficacy of endoscopic injection in the adult population with vesicoureteral reflux (VUR). The search for VUR is a part of the standard workup of children with febrile urinary tract infections. However, VUR can present later in life and should be investigated in the case of recurrent pyelonephritis.
From 2005 to 2009, 27 postpubertal patients (3 males and 24 females) were treated endoscopically with injection of polydimethylsiloxane (Macroplastique) in 13 or dextranomer/hyaluronic acid copolymer (Deflux) in 14 patients; 41 renal units were injected. The median age was 23 years (range 12-65). The VUR was evaluated as grade I in 5 ureters, grade II in 28, grade III in 7, and grade IV in 1. The indications for surgery were recurrent pyelonephritis in all patients, except for 1. Of the 27 patients, 5 (12%) had undergone previous ureteral surgery. The patients were followed up with renal ultrasonography and voiding cystourethrography.
VUR was corrected in 38 (93%) of 41 ureteral units. Of the 3 failures, 1 patient had a large Hutch diverticulum and another had previously undergone ureterocele incision. All the patients with treatment failure had been injected with dextranomer/hyaluronic acid copolymer. Thus, the success rate was 100% with polydimethylsiloxane and 87% with dextranomer/hyaluronic acid copolymer. De novo hydronephrosis appeared in 1 renal unit. The obstruction was confirmed by a mercaptoacetyltriglycine-Lasix technetium-99m scan and treated with temporary diversion using a double-J stent.
Endoscopic injection is an effective treatment of VUR after puberty. In cases of recurrent pyelonephritis, imaging should be mandatory to detect scars and VUR because the endoscopic treatment is simple and noninvasive and has a good success rate, comparable to that reported for children.
前瞻性评估内镜注射在成人膀胱输尿管反流（VUR）患者中的疗效。VUR 的发现是儿童发热性尿路感染标准检查的一部分。然而，VUR 也可能在以后的生活中出现，在复发性肾盂肾炎的情况下应进行调查。
2005 年至 2009 年，对 27 例青春期后患者（3 名男性和 24 名女性）进行内镜下治疗，13 例患者注射聚二甲基硅氧烷（Macroplastique），14 例患者注射葡聚糖/透明质酸共聚物（Deflux）；共注射 41 个肾脏单位。中位年龄为 23 岁（范围 12-65 岁）。5 个输尿管的 VUR 分级为 I 级，28 个为 II 级，7 个为 III 级，1 个为 IV 级。所有患者的手术指征均为复发性肾盂肾炎，除 1 例患者外。27 例患者中，5 例（12%）曾行输尿管手术。患者接受肾超声和排尿性膀胱尿道造影随访。
41 个输尿管单位中有 38 个（93%）VUR 得到纠正。3 例治疗失败，1 例患者有巨大的 Hutch 憩室，另 1 例患者曾行输尿管囊肿切开术。所有治疗失败的患者均接受葡聚糖/透明质酸共聚物注射。因此，聚二甲基硅氧烷的成功率为 100%，葡聚糖/透明质酸共聚物的成功率为 87%。1 个肾脏单位出现新发肾积水。经巯基乙酰三甘氨酸-速尿 99mTc 扫描证实存在梗阻，并使用双 J 支架进行临时引流。
青春期后内镜注射是治疗 VUR 的有效方法。在复发性肾盂肾炎的情况下，应进行影像学检查以发现瘢痕和 VUR，因为内镜治疗简单、无创，成功率高，与儿童报道的成功率相当。
