Fuentes Sara, Gómez-Fraile Andrés, Carrillo-Arroyo Isabel, Tordable-Ojeda Cristina, Cabezalí-Barbancho Daniel
Pediatric Surgery Division, Complejo Asistencial Universitario de León, León, Spain.
Pediatric Surgery Division, 12 de Octubre University Hospital, Madrid, Spain.
Urology. 2017 Dec;110:196-200. doi: 10.1016/j.urology.2017.08.005. Epub 2017 Aug 14.
To evaluate the outcomes of endoscopic treatment of vesicoureteral reflux (VUR) performed on infants, and to discuss the possible role of this approach in selected cases.
A retrospective analysis was conducted on the patients who underwent endoscopic injection of a bulking substance for VUR in our institution, and a comparison was made with patients treated during infancy and those treated later in life.
A total of 463 ureteral units were included (296 children), of whom 47 were patients less than 1 year of age (infants, INF group); the remaining 416 were included in a second group (children, CHL). In this study, the percentage of high-grade VUR and presence of reflux nephropathy were significantly higher in younger patients. Both early failure and recurrence rate were significantly higher in the INF group when compared with the CHL group. No complications were observed in the INF group.
Endoscopic treatment of VUR is feasible in patients less than 1 year of age. The effectiveness is lower than when patients are treated at a later age but was still over 80% in our series. There were no complications reported related to the procedure itself or to the general anesthesia. Once it is known that endoscopic treatment of VUR can be performed, controversy arises about the indication of treating patients with VUR. Careful selection of VUR cases that are less likely to spontaneously resolve, presence of breakthrough infections, and parental preference, all play a role in the decision-making process.
评估对婴儿进行膀胱输尿管反流（VUR）内镜治疗的效果，并探讨该方法在特定病例中的可能作用。
对在我院接受内镜下注射填充剂治疗VUR的患者进行回顾性分析，并与婴儿期接受治疗的患者以及 later in life 接受治疗的患者进行比较。
共纳入463个输尿管单位（296名儿童），其中47名是年龄小于1岁的患者（婴儿，INF组）；其余416名纳入第二组（儿童，CHL组）。在本研究中，年轻患者中重度VUR的百分比和反流性肾病的发生率显著更高。与CHL组相比，INF组的早期失败率和复发率均显著更高。INF组未观察到并发症。
对年龄小于1岁的患者进行VUR内镜治疗是可行的。其有效性低于 later in life 治疗的患者，但在我们的系列研究中仍超过80%。未报告与手术本身或全身麻醉相关的并发症。一旦知道可以进行VUR内镜治疗，关于VUR患者治疗指征的争议就会出现。仔细选择不太可能自发缓解的VUR病例、突破性感染的存在以及家长的偏好，都在决策过程中发挥作用。
