Department of Pediatric Urology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
J Urol. 2012 Jul;188(1):258-61. doi: 10.1016/j.juro.2012.03.019. Epub 2012 May 15.
We histologically investigated the cause of failed endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid injections in children.
A total of 192 children underwent dextranomer/hyaluronic acid injection at our institution between January 2008 and September 2010. The study population consisted of 13 children (22 ureters) with vesicoureteral reflux who underwent ureteroneocystostomy following failed endoscopic injections (1 to 2) of dextranomer/hyaluronic acid. In all cases the dextranomer/hyaluronic acid was implanted in the mucosa of the mid to distal ureteral tunnel following hydrodistention of the ureter. The medical records were reviewed, and specimens of the archived distal ureters removed during surgery were examined histologically.
Mean patient age was 4.1 years. Mean dose of dextranomer/hyaluronic acid was 0.9 ml (both treatments) and mean lag between treatments was 13.4 months. Indications for open surgery were recurrent urinary tract infections and/or residual or aggravated reflux grade IV or higher. Histological study revealed that the dextranomer/hyaluronic acid was malpositioned in 21 of 22 ureters, residing in the muscle fibers in 2, adventitia in 14 and periureteral space in 5.
This is the first known study to provide a histologically proved cause of failure of endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid injections in children. Malpositioning of the material outside the submucosal ureter was identified in a high percentage of cases. Larger studies are needed to corroborate these findings.
我们通过组织学检查，研究了儿童行透明质酸钠/聚糖 羟丁酯（DX-HA）注射治疗失败的原因。
2008 年 1 月至 2010 年 9 月期间，我们共对 192 例儿童进行了 DX-HA 注射。该研究人群包括 13 例（22 侧输尿管）儿童，他们在 DX-HA 注射（1 至 2 次）治疗失败后接受了输尿管再植术。所有病例均在输尿管扩张后，将 DX-HA 注入到输尿管中段至远段的黏膜下隧道。我们回顾了病历，并对术中切除的存档远端输尿管标本进行了组织学检查。
患者平均年龄为 4.1 岁。DX-HA 的平均剂量为 0.9ml（两次治疗），两次治疗的平均间隔时间为 13.4 个月。开放手术的指征是复发性尿路感染和/或残留或加重的反流 IV 级或更高级别。组织学研究显示，22 侧输尿管中有 21 侧 DX-HA 错位，2 侧位于肌肉纤维内，14 侧位于外膜下，5 侧位于输尿管周围间隙。
这是首例已知的研究，提供了 DX-HA 注射治疗儿童膀胱输尿管反流失败的组织学原因。在很大比例的病例中，发现材料错位到黏膜下输尿管外。需要更大的研究来证实这些发现。
