Chiba Hiroki, Kitta Takeya, Higuchi Madoka, Kusakabe Naohisa, Kon Masafumi, Nakamura Michiko, Shinohara Nobuo
Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, North-15 West-7 Kita-Ku, Sapporo, 060-8638, Japan.
BMC Urol. 2022 Mar 29;22(1):48. doi: 10.1186/s12894-022-00997-7.
To investigate the need for ureteral reimplantation for vesicoureteral reflux (VUR) during augmentation cystoplasty (AC) in the long term.
A total of 19 patients with a median age at surgery of 14 years (3-38 years) who underwent AC for neurogenic bladder with VUR between 1983 and 2016 were included in this study. The changes in VUR grade and urodynamic findings were retrospectively evaluated. We evaluated the renal function by periodic inspection of serum creatinine level and estimated glomerular filtration rate; eGFR.
The median follow-up period from AC was 14.8 years (5.7-30 years). VUR was detected in 19 patients, involving 27 ureters. Reflux grade was V in 6, IV in 9, III in 5, II in 6, and I in 1. Ureteral reimplantation was not performed in 18 patients (26 ureters), whereas it was done for 1 patient (1 ureter) in the early era of our experience. Postoperative videourodynamics showed that the reflux was radiologically not verifiable in 23 ureters (85%), was downgraded in 3 ureters (11%), and was unchanged in 1 ureter (3%). There were no cases of deterioration of VUR.
Ureteral reimplantation is not necessary for VUR during augmentation cystoplasty.
长期研究扩大膀胱成形术（AC）期间因膀胱输尿管反流（VUR）而进行输尿管再植术的必要性。
本研究纳入了1983年至2016年间因神经源性膀胱合并VUR接受AC手术的19例患者，手术时的中位年龄为14岁（3 - 38岁）。对VUR分级和尿动力学检查结果的变化进行回顾性评估。我们通过定期检查血清肌酐水平和估算肾小球滤过率（eGFR）来评估肾功能。
AC术后的中位随访期为14.8年（5.7 - 30年）。19例患者检测到VUR，累及27条输尿管。反流分级为V级6条，IV级9条，III级5条，II级6条，I级1条。18例患者（26条输尿管）未进行输尿管再植术，而在我们经验的早期，有1例患者（1条输尿管）进行了输尿管再植术。术后膀胱尿道造影显示，23条输尿管（85%）放射学上无法证实存在反流，3条输尿管（11%）反流程度降低，1条输尿管（3%）反流情况未变。没有VUR恶化的病例。
扩大膀胱成形术期间因VUR进行输尿管再植术并非必要。
