Bawazir Osama
MD, Consultant Paediatric Surgeon, Department of Surgery, Faculty of Medicine, Umm Al-qura University, Mecca, Kingdom of Saudi Arabia.
Electron Physician. 2017 Apr 25;9(4):4145-4149. doi: 10.19082/4145. eCollection 2017 Apr.
Vesicoureteral reflux is a risk factor for progressive renal damage. In addition to long-term antibiotic prophylaxis and open surgical re-implantation, endoscopic sub-mucosal intra-ureteral injection of implant material is a therapeutic alternative that gained a world-wide preference.
The aim of this study was to determine the effectiveness and safety of the implant material, dextranomer/hyaluronic acid, in a cohort of Saudi children with vesicoureteral reflux.
In this case-series study, 61 patients with vesicoureteral reflux, who were 7 months to 10 years old (mean age 2.6 years), underwent sub-mucosal intra-ureteral injection of dextranomer/hyaluronic acid at our institutions in the period from October 2003 to October 2013. The operative protocol was the same in all institutions. Dextranomer/hyaluronic acid was injected submucosally within the intramural ureter (modified STING). Renal ultrasonography was performed to detect the presence of hydronephrosis. At 6 weeks' fluoroscopic voiding cystourethrograms were used to evaluate the success of the technique. Data were analysed by SPSS version 19 using Pearson Chi square, Fisher's Exact and Cramér's V test.
Reflux was corrected in 44 patients out of 61 (72.13%) and in 60 (75.00%) out of 80 ureteric units. Statistically, there was no significant difference (p>0.05) in success rate of the technique according to gender, age group and unilateral vs. bilateral cases. The success rate was significantly (p=0.025) higher in the lower grades (I-III) (87.50%) compared to grade IV (73.53%) and grade V (50.00%). No complications related to the technique were reported. The technique had failed in 17 patients (27.87%) or 20 ureters (25.00%). These cases underwent open surgery.
Sub-mucosal intra-ureteral implantation with dextranomer/hyaluronic acid by the modified STING technique is a simple, safe and effective outpatient procedure for vesicoureteral reflux.
膀胱输尿管反流是进行性肾损害的一个危险因素。除了长期抗生素预防和开放手术再植术外，内镜下输尿管黏膜下注射植入材料是一种在全球范围内受到青睐的治疗选择。
本研究旨在确定植入材料葡聚糖/透明质酸在一组沙特膀胱输尿管反流患儿中的有效性和安全性。
在本病例系列研究中，2003年10月至2013年10月期间，61例年龄在7个月至10岁（平均年龄2.6岁）的膀胱输尿管反流患者在我们的机构接受了输尿管黏膜下注射葡聚糖/透明质酸。所有机构的手术方案相同。葡聚糖/透明质酸在壁内输尿管内黏膜下注射（改良STING）。进行肾脏超声检查以检测肾积水的存在。在6周时，使用荧光透视排尿膀胱尿道造影来评估该技术的成功率。使用SPSS 19版软件，采用Pearson卡方检验、Fisher精确检验和Cramér's V检验对数据进行分析。
61例患者中有44例（72.13%）反流得到纠正，80个输尿管单位中有60个（75.00%）反流得到纠正。从统计学上看，根据性别、年龄组以及单侧与双侧病例，该技术的成功率没有显著差异（p>0.05）。较低分级（I - III级）的成功率（87.50%）显著高于IV级（73.53%）和V级（50.00%）（p = 0.025）。未报告与该技术相关的并发症。该技术在17例患者（27.87%）或20个输尿管（25.00%）中失败。这些病例接受了开放手术。
通过改良STING技术在输尿管黏膜下植入葡聚糖/透明质酸是一种治疗膀胱输尿管反流的简单、安全且有效的门诊手术。
