Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2018 Aug 8;33(38):e240. doi: 10.3346/jkms.2018.33.e240. eCollection 2018 Sep 17.
To report the long-term outcomes of endoscopic surgery (ES) in pediatric patients with vesicoureteral reflux in terms of success rate, urinary tract infection, and renal function.
We retrospectively reviewed the records of 73 pediatric patients (110 ureters) who underwent ES for vesicoureteral reflux. Ultrasonography was performed 1, 3, and 12 months postoperatively. Voiding cystourethrography was performed 3 months postoperatively and repeated after 1 year if vesicoureteral reflux persisted. Success was defined as the absence of reflux at the first voiding cystourethrography. Renal scans were performed at least 12 months postoperatively. Renal function deterioration was defined as a new scar or a greater than 5% decrease in function.
The median follow-up duration was 24 (12-118) months. The overall success was 65.6%, while it was 78.9%, 87.0%, 62.5%, 37.5%, 66.7% for grades I, II, III, IV, and V, respectively. In multivariate analyses, significant predictive factors for success were vesicoureteral reflux grade (odds ratio [OR], 0.28; < 0.001) and mound detection at the first postoperative ultrasonography (OR, 13.53; < 0.001). Renal function deterioration was found in 8 (15.3%) ureters and was less common in those with successful surgeries than in those with failures (9.5% vs. 40.0%; = 0.035). No significant predictive factor for renal function deterioration or urinary tract infection was found.
Successful short-term outcomes of ES are expected in low-grade vesicoureteral reflux, especially when a mound is detected by postoperative ultrasonography. However, unpredictable long-term renal deterioration warrants continued follow-up.
本研究旨在报告儿童膀胱输尿管反流患者内镜手术（ES）的长期疗效，包括成功率、尿路感染和肾功能。
我们回顾性分析了 73 例（110 侧输尿管）接受 ES 治疗的小儿膀胱输尿管反流患者的临床资料。术后 1、3 和 12 个月行超声检查。术后 3 个月行排尿性膀胱尿道造影（VCUG），如果存在反流则于 1 年后重复检查。首次 VCUG 无反流定义为手术成功。术后至少 12 个月行肾扫描。如果出现新发瘢痕或功能下降超过 5%则定义为肾功能恶化。
中位随访时间为 24（12-118）个月。总体手术成功率为 65.6%，Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ级的成功率分别为 78.9%、87.0%、62.5%、37.5%和 66.7%。多因素分析显示，影响手术成功率的因素包括膀胱输尿管反流级别（比值比 [OR]，0.28； < 0.001）和术后首次超声检查发现丘状结构（OR，13.53； < 0.001）。8 侧输尿管（15.3%）出现肾功能恶化，手术成功组肾功能恶化发生率低于手术失败组（9.5%比 40.0%； = 0.035）。未发现肾功能恶化或尿路感染的预测因素。
对于低级别膀胱输尿管反流，ES 短期疗效较好，特别是术后超声检查发现丘状结构时。然而，长期肾功能不可预测的恶化仍需要密切随访。
