Han Daniel S, Cambareri Gina, Alagiri Madhu, Chiang George
Pediatric Urology, University of California San Diego, Rady Children's Hospital, San Diego, CA.
Pediatric Urology, University of California San Diego, Rady Children's Hospital, San Diego, CA.
Urology. 2019 Feb;124:237-240. doi: 10.1016/j.urology.2018.09.034. Epub 2018 Oct 29.
To determine whether vesicoureteral reflux (VUR) that occurs during either the filling or voiding phase on voiding cystourethrogram (VCUG) has prognostic significance on successful endoscopic treatment.
A retrospective review was performed of 299 patients (438 ureters) with VUR who underwent endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux) at a single institution from 2010 to 2013. Success was defined as absence of VUR on 3-month follow-up VCUG. Preoperative VCUGs were analyzed to determine whether the onset of VUR occurred during the filling or voiding phase. Predictor variables to determine success were analyzed, with a specific focus on VUR timing.
Success rate was 319/438 (72.8%) by ureter and 202/299 (67.6%) by patient. Reflux was seen during the filling and voiding phases in 290 and 148 ureters, respectively. Success rate was 203/290 (78%) for filling VUR and 116/148 (70%) for voiding VUR. Univariable analysis revealed voiding VUR had significantly increased odds of success (odds ratio [OR] 3.2, P = .049), while high-grade reflux (OR 0.53, P = .005) had significantly decreased odds of success. Multivariable analysis showed that voiding VUR (OR 3.2, P = .005) had significantly higher odds of success while those with high grade reflux (OR 0.42, P = .017) had significantly decreased odds of success.
The timing of VUR on preoperative VCUG appears to be an important independent predictor of successful endoscopic treatment of VUR. This has important clinical considerations when selecting VUR patients who would be best candidates for endoscopic treatment.
确定排尿性膀胱尿道造影（VCUG）充盈期或排尿期出现的膀胱输尿管反流（VUR）对内镜治疗成功与否是否具有预后意义。
对2010年至2013年在单一机构接受葡聚糖omer/透明质酸共聚物（Deflux）内镜治疗的299例VUR患者（438条输尿管）进行回顾性研究。成功定义为3个月随访VCUG时无VUR。分析术前VCUG以确定VUR发作是发生在充盈期还是排尿期。分析确定成功的预测变量，特别关注VUR发生时间。
按输尿管计算成功率为319/438（72.8%），按患者计算为202/299（67.6%）。分别在290条和148条输尿管的充盈期和排尿期观察到反流。充盈期VUR的成功率为203/290（78%），排尿期VUR的成功率为116/148（70%）。单因素分析显示，排尿期VUR成功的几率显著增加（优势比[OR]3.2，P = 0.049），而高级别反流（OR 0.53，P = 0.005）成功的几率显著降低。多因素分析表明，排尿期VUR（OR 3.2，P = 0.005）成功的几率显著更高，而高级别反流患者（OR 0.42，P = 0.017）成功的几率显著降低。
术前VCUG上VUR的发生时间似乎是VUR内镜治疗成功的重要独立预测因素。在选择最适合内镜治疗的VUR患者时，这具有重要的临床意义。
