Akdeniz University Organ Transplantation Institute, Antalya, Turkey.
BJU Int. 2013 Aug;112(4):E366-71. doi: 10.1111/bju.12016. Epub 2013 Feb 27.
To evaluate the outcome of anti-reflux revision surgery in patients diagnosed with at least a grade 3 reflux at voiding cysto-urethrography in patients with recurrent urinary tract infection (UTI) after renal transplantation.
We identified 60 patients with a diagnosis of recurrent febrile UTI and post-transplantation vesico-ureteric reflux (VUR) who underwent open surgical correction of reflux. Patient characteristics, including the aetiology of end-stage renal disease, age, time to VUR correction, type of VUR correction, serum creatinine levels, and number of UTIs before and after correction were documented.
The median (range) age of the patients was 31.5 (9-65) years. A total of 30 patients underwent uretero-ureterostomy or pyelo-ureterostomy and 30 underwent extravesical or intravesical ureteric reimplantation. The median (range) creatinine levels before and after correction were 1.5 (0.8-4.5) mg/dL and 1.3 (0.7-4.5) mg/dL (P<0.05), respectively. The median (range) number of UTI episodes reported before the correction surgery was 4 (3-12), whereas number of UTI episodes after the surgery was 1 (0-12), the difference being significant (P<0.05).
Open surgical correction of post-transplant VUR is an effective and safe method of decreasing UTI episodes and stopping reflux. Surgical correction of reflux may prolong the life of the renal graft.
评估在因反复尿路感染（UTI）而行肾移植后，在排尿性膀胱尿道造影中至少有 3 级反流的患者中，行抗反流修正手术的结果。
我们确定了 60 例有复发性发热性 UTI 和移植后膀胱输尿管反流（VUR）的患者，这些患者均行开放性手术矫正反流。记录患者的特征，包括终末期肾病的病因、年龄、VUR 矫正时间、VUR 矫正类型、血清肌酐水平以及矫正前后的 UTI 次数。
患者的中位数（范围）年龄为 31.5（9-65）岁。共有 30 例患者行输尿管-输尿管吻合术或肾盂-输尿管吻合术，30 例行膀胱外或膀胱内输尿管再植入术。矫正前后的中位数（范围）肌酐水平分别为 1.5（0.8-4.5）mg/dL 和 1.3（0.7-4.5）mg/dL（P<0.05）。矫正手术前报告的 UTI 发作中位数（范围）为 4（3-12）次，而手术后为 1（0-12）次，差异有统计学意义（P<0.05）。
开放手术矫正移植后 VUR 是减少 UTI 发作和停止反流的有效且安全的方法。反流的手术矫正可能会延长肾移植物的寿命。
