Çilesiz Nusret Can, Onuk Özkan, Özkan Arif, Kalkanlı Arif, Gezmiş Cem Tuğrul, Nuhoğlu Barış
Department of Urology, Biruni University, Istanbul, Turkey.
Department of Urology, Istanbul Koç University, Istanbul, Turkey.
Int Urol Nephrol. 2022 May;54(5):1023-1029. doi: 10.1007/s11255-022-03152-1. Epub 2022 Feb 21.
This study aimed to identify and describe the outcomes of different endoscopic treatments and the predictive factors affecting success in the treatment of symptomatic vesicoureteral reflux (VUR) after kidney transplantation.
Patients who had undergone endoscopic injection treatment for symptomatic VUR detected by VCUG with at least 1-year follow-up were included in the study. Patients with dysfunctional and/or obstructive voiding patterns were excluded from the study. We retrospectively evaluated the patient's characteristics, operative information about the type of injection (one, two, or four-point) and the bulking agent (DX-HA, PPC), and perioperative data. Clinical success was defined as no febrile UTI, and radiological success was defined as the absence of VUR in VCUG 3 months after the operation. Clinical success, radiological success, and encountered complications were statistically analyzed.
A total of 76 patients were included in this study. The one-point, two-point, and four-point injection technique was applied to 32 (42.1%), 13 (17.1%), and 31 (40.7%) of patients, respectively. PPC and DX-HA were used as bulking agents in 54 (71.1%) and 22 (28.9%) patients, respectively. The clinical success rate was 73.7% (n = 56). In logistic regression analysis, a significant efficacy of the four-point technique was observed in the univariate analysis of clinical success (p = 0.042). The radiological success rate was 40.8% (n = 31). In the logistic regression analysis, DX-HA and PPC radiological success was attained in 4 (18.1%) and 27 (50%) patients, respectively (p = 0.01). Ureterovesical junction (UV) stricture developed in 5 (6.5%) patients. There was no difference between injection techniques and bulking agents in terms of the development of UV stricture (p = 0.32; p = 0.08).
The success of endoscopic treatment in patients with VUR after kidney transplantation can be increased by multiple injections. Furthermore, PPC can be used to obtain a higher radiological success.
本研究旨在确定并描述不同内镜治疗的结果以及影响肾移植后症状性膀胱输尿管反流（VUR）治疗成功的预测因素。
纳入经排尿性膀胱尿道造影（VCUG）检测出症状性VUR并接受内镜注射治疗且随访至少1年的患者。有排尿功能障碍和/或梗阻性排尿模式的患者被排除在研究之外。我们回顾性评估了患者的特征、注射类型（一点、两点或四点）和填充剂（DX-HA、PPC）的手术信息以及围手术期数据。临床成功定义为无发热性尿路感染，放射学成功定义为术后3个月VCUG检查无VUR。对临床成功、放射学成功和所遇到的并发症进行了统计分析。
本研究共纳入76例患者。一点、两点和四点注射技术分别应用于32例（42.1%）、13例（17.1%）和31例（40.7%）患者。分别有54例（71.1%）和22例（28.9%）患者使用PPC和DX-HA作为填充剂。临床成功率为73.7%（n = 56）。在逻辑回归分析中，临床成功的单因素分析显示四点技术具有显著疗效（p = 0.042）。放射学成功率为40.8%（n = 31）。在逻辑回归分析中，分别有4例（18.1%）和27例（50%）患者使用DX-HA和PPC获得放射学成功（p = 0.01）。5例（6.5%）患者发生输尿管膀胱连接部（UV）狭窄。在UV狭窄的发生方面，注射技术和填充剂之间没有差异（p = 0.32；p = 0.08）。
肾移植后VUR患者的内镜治疗通过多次注射可提高成功率。此外，使用PPC可获得更高的放射学成功率。
