Fotso Kamdem Arnaud, Galli Giacomo, Aubert Didier
Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, 25000 Besancon, France.
J Pediatr Urol. 2014 Feb;10(1):56-61. doi: 10.1016/j.jpurol.2013.06.002. Epub 2013 Jun 26.
To assess the long-term incidence of febrile urinary tract infection (fUTI) in children treated by endoscopic injection of dextranomer/hyaluronic acid (DxHA) for vesicoureteral reflux (VUR).
Prospective study from January 2002 to December 2009 in children treated at our institution for VUR by endoscopic injection of DxHA. All children underwent clinical and renal/bladder ultrasound follow up at 3 months after procedure, then annually. Post-operative voiding cystourethrogram (VCUG) control was performed only for patients with recurrent fUTI.
227 children (177 female) were included. Mean patient age at inclusion was 4.7 years. The mean duration of follow-up was 51.6 months. During follow-up, 18.9% had one or several fUTIs, of whom 48.8% had VUR at VCUG. No recurrence of fUTI was observed after 4 years of follow-up. We identified three risk factors for fUTI recurrence: cystitis cystica at the time of injection (p = 0.007), preoperative renal scarring (p = 0.018), and the disappearance of the implant at 3-month follow-up ultrasound (p = 0.037).
The long-term incidence of recurrent fUTI after endoscopic treatment of VUR is low. Our data show that the clinical results of endoscopic treatment should be interpreted with a follow up of at least 4 years.
评估经内镜注射葡聚糖omer/透明质酸（DxHA）治疗膀胱输尿管反流（VUR）的儿童发热性尿路感染（fUTI）的长期发生率。
对2002年1月至2009年12月在本机构接受内镜注射DxHA治疗VUR的儿童进行前瞻性研究。所有儿童在术后3个月进行临床及肾脏/膀胱超声随访，之后每年随访一次。仅对复发性fUTI患者进行术后排尿性膀胱尿道造影（VCUG）检查。
纳入227名儿童（177名女性）。纳入时的平均患者年龄为4.7岁。平均随访时间为51.6个月。随访期间，18.9%的儿童发生过一次或多次fUTI，其中48.8%的儿童在VCUG检查时有VUR。随访4年后未观察到fUTI复发。我们确定了fUTI复发的三个危险因素：注射时的囊性膀胱炎（p = 0.007）、术前肾瘢痕形成（p = 0.018）以及3个月随访超声时植入物消失（p = 0.037）。
内镜治疗VUR后复发性fUTI的长期发生率较低。我们的数据表明，内镜治疗的临床结果应至少随访4年才能进行解读。
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