López P-J, Reed F, Ovalle A, Celis S, Reyes D, Letelier N, Zubieta R
Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Barros Luco 3301, San Miguel, Santiago, Chile; University of Chile, School of Medicine, Department of Pediatrics and Pediatric Surgery, Santiago, Chile; Clinica Alemana, Santiago, Chile.
Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Barros Luco 3301, San Miguel, Santiago, Chile.
J Pediatr Urol. 2014 Oct;10(5):831-4. doi: 10.1016/j.jpurol.2014.02.002. Epub 2014 Mar 12.
This study was designed to investigate whether post-endoscopic treatment (ET) intraoperative cystography is predictive of treatment outcome.
Patients diagnosed with vesicoureteral reflux (VUR) and treated endoscopically with polyacrylate/polyalcohol copolymer or dextranomer hyaluronic acid were studied prospectively between August 2009 and April 2011. Slow infusion pre-ET cystography was performed under anesthesia. Post-ET cystography was performed only if the intraoperative pre-ET results demonstrated VUR.
Over a period of 20 months, 23 patients were studied (18 girls, five boys), with an average age of 41.9 months (range 13 months-11 years). Thirty-two renal units with reflux were treated: nine bilateral cases, seven right, and seven left. The distribution of reflux grades was as follows: two grade I, 10 grade II, 11 grade III, nine grade IV. All injected ureters demonstrated grade 0 hydrodistention after the procedure. Twelve of 23 of the pre-ET cystography results were negative for VUR, indicating that the sensitivity of this test is 47% compared with the preoperative voiding cystourethrography (VCUG) or nuclear cystogram. There were no procedure complications.
Of all patients (n = 23), nearly 60% did not demonstrate pre-ET VUR on intraoperative cystography. If a postoperative VCUG had been performed on all patients, more than half would have received unnecessary radiation. Therefore, this study demonstrates that post-ET cystography does not predict the success of ET of VUR intraoperative. Pre-ET cystography under general anesthesia before ureteral injection, has very low sensitivity, creating false-negatives that may complicate the interpretation of post-ET cystography. We suggest that intraoperative cystography before and after ET fails to show clinical utility and should not be used to predict the outcome of endoscopic VUR treatment.
本研究旨在调查内镜治疗（ET）术后术中膀胱造影是否可预测治疗结果。
对2009年8月至2011年4月期间前瞻性研究的诊断为膀胱输尿管反流（VUR）并接受聚丙烯酸酯/多元醇共聚物或葡聚糖凝胶透明质酸内镜治疗的患者进行研究。在麻醉下进行缓慢输注ET前膀胱造影。仅当术中ET前结果显示VUR时才进行ET后膀胱造影。
在20个月的时间里，研究了23例患者（18名女孩，5名男孩），平均年龄41.9个月（范围13个月至11岁）。对32个有反流的肾单位进行了治疗：9例双侧病例，7例右侧，7例左侧。反流分级分布如下：2例I级，10例II级，11例III级，9例IV级。术后所有注入的输尿管均显示0级扩张。23例ET前膀胱造影结果中有12例VUR为阴性，表明该检查与术前排尿性膀胱尿道造影（VCUG）或核素膀胱造影相比敏感性为47%。无手术并发症。
在所有患者（n = 23）中，近60%在术中膀胱造影时未显示ET前VUR。如果对所有患者进行术后VCUG检查，超过一半的患者将接受不必要的辐射。因此，本研究表明ET后膀胱造影不能预测VUR内镜治疗术中的成功与否。输尿管注射前全身麻醉下的ET前膀胱造影敏感性非常低，会产生假阴性结果，可能使ET后膀胱造影的解读复杂化。我们建议ET前后的术中膀胱造影未显示临床实用性，不应被用于预测内镜下VUR治疗的结果。
