Division of Pediatric Urology, Miami Children's Hospital Department of Urology, University of Miami, FL, USA.
J Urol. 2011 Jun;185(6 Suppl):2531-4. doi: 10.1016/j.juro.2011.01.014. Epub 2011 Apr 28.
Endoscopic injection of dextranomer-hyaluronic acid copolymer is an accepted initial procedure to correct vesicoureteral reflux. Less data are available on its role in treating failed ureteral reimplantation.
We retrospectively reviewed the charts from 2002 to 2008 and identified 21 patients (26 ureteral units) with persistent reflux after reimplantation.
Mean age was 7 years (range 2 to 13). Mean followup was 2 years (range 10 to 46 months). Of the 17 patients with a single system ureteral reimplantation was extravesical in 9 and intravesical in 8 with tapering performed in 5. Three patients underwent reimplantation of duplex systems and 1 underwent reimplantation due to ureterocele. Residual reflux grade was 1 to 4 in 3 (11%), 17 (65%), 3 (11%) and 3 ureteral units (11%), respectively. Dextranomer-hyaluronic acid copolymer was injected transurethrally. The mean volume injected was 1.2 ml (range 0.7 to 3). After 1 injection reflux resolved in 15 patients (71%) or a total of 20 ureteral units (77%), including 12 of 14 (86%) extravesically and 8 of 12 (66%) intravesically reimplanted units. The resolution rate improved to 84% after multiple injections. Two of the 6 patients with reflux after 1 injection had a single system, 2 had an obstructive megaureter with tapered reimplantation, 1 had a duplicated system and 1 had a ureterocele. Three of the 5 patients with persistent reflux underwent revision surgery. Ureteral abnormalities other than reflux and tapered reimplantation were associated with a statistically significant inferior success rate.
Dextranomer-hyaluronic acid copolymer injection is an efficacious salvage procedure for persistent reflux after ureteral reimplantation. The success rate is inferior for ureteral abnormalities other than primary vesicoureteral reflux and after tapering.
透明质酸钠-聚糖酐微球胶是一种治疗膀胱输尿管反流的方法。然而，其在治疗输尿管再植术后失败的作用的数据相对较少。
我们回顾了 2002 年至 2008 年的病历，并确定了 21 例（26 个输尿管单位）患者在输尿管再植术后仍存在反流。
平均年龄为 7 岁（范围 2 至 13 岁）。平均随访时间为 2 年（范围 10 至 46 个月）。17 例患者中，9 例为经皮输尿管再植术，8 例为经膀胱输尿管再植术，其中 5 例采用了输尿管成形术。3 例患者接受了双输尿管再植术，1 例因输尿管囊肿而接受了再植术。残余反流程度为 3 级的有 3 个输尿管单位（11%），4 级的有 3 个输尿管单位（11%），17 个输尿管单位（65%）为 1 级，3 个输尿管单位（11%）为 2 级。透明质酸钠-聚糖酐微球胶通过经尿道注射。平均注射量为 1.2ml（范围 0.7 至 3）。1 次注射后，15 例患者（71%）或 20 个输尿管单位（77%）的反流得到缓解，其中 14 个经皮输尿管再植术的患者中有 12 例（86%），12 个经膀胱输尿管再植术的患者中有 8 例（66%）。多次注射后，缓解率提高至 84%。6 例首次注射后仍有反流的患者中，2 例为单系统，2 例为梗阻性巨输尿管伴输尿管成形术，1 例为双输尿管，1 例为输尿管囊肿。3 例持续性反流患者接受了手术修复。除反流和输尿管成形术外，输尿管异常与统计学上较低的成功率相关。
透明质酸钠-聚糖酐微球胶注射是治疗输尿管再植术后持续性反流的有效补救方法。原发性膀胱输尿管反流和输尿管成形术后，除反流和输尿管成形术外，其他输尿管异常的成功率较低。
