Department of Urology, Gaziantep 25 Aralık State Hospital, Gaziantep, Turkey.
School of Medicine, Department of Urology, University of Gaziantep, 27410, Gaziantep, Turkey.
Surg Today. 2024 Oct;54(10):1265-1271. doi: 10.1007/s00595-024-02833-x. Epub 2024 Apr 16.
To evaluate the effectiveness of preoperative ultrasound (US) measurements in predicting pediatric vesicoureteral reflux (VUR) treatment outcomes.
This prospective study enrolled 35 patients (53 renal units) aged 1-16 years who underwent subureteric injection therapy for primary VUR between July 2020 and June 2022. Preoperative ultrasound examinations measured the bladder wall thickness at the ureteral orifice, ureteral submucosal tunnel length, distal ureteral diameter, patient demographics, VUR grade, presenting complaints, bladder-bowel dysfunction, and renal scarring, and the impact of these variables on treatment success was analyzed.
Among the patients, 91.4% were female, with a mean age of 6.83 ± 3.84 years. A comparison between the treatment success and failure groups revealed no significant differences in the age, sex, VUR grade, laterality, bilaterality, presenting complaints, bladder-bowel dysfunction, bladder wall thickness, or distal ureteral diameter (p > 0.05). However, renal scarring occurred in 16 (38.1%) patients in the treatment success group and 10 (90.9%) in the treatment failure group (p = 0.002). The treatment failure group had shorter detrusor-to-ureteral orifice distances and smaller detrusor-ureteral orifice distance-to-distal ureteral diameter (D/U) ratios than that of the success group (p = 0.004 and p = 0.006, respectively). Patients with a detrusor-to-ureteral orifice distance < 7.4 mm had an 81.82% likelihood of treatment failure.
Ultrasound measurements of the detrusor-to-ureteral orifice distance and D/U ratio proved reliable in predicting the success of endoscopic subureteric injection therapy for VUR.
评估术前超声（US）测量在预测小儿膀胱输尿管反流（VUR）治疗结果中的有效性。
本前瞻性研究纳入了 2020 年 7 月至 2022 年 6 月间因原发性 VUR 接受输尿管下注射治疗的 35 名（53 个肾脏单位）年龄在 1-16 岁的患者。术前超声检查测量了输尿管口处膀胱壁厚度、输尿管黏膜下隧道长度、远段输尿管直径、患者人口统计学资料、VUR 分级、临床表现、膀胱肠道功能障碍和肾瘢痕，并分析了这些变量对治疗成功的影响。
患者中 91.4%为女性，平均年龄为 6.83±3.84 岁。治疗成功组与失败组间比较，年龄、性别、VUR 分级、侧别、双侧性、临床表现、膀胱肠道功能障碍、膀胱壁厚度或远段输尿管直径无显著差异（p＞0.05）。然而，治疗成功组中有 16 例（38.1%）患者存在肾瘢痕，而治疗失败组中有 10 例（90.9%）（p=0.002）。失败组的膀胱输尿管口距离和膀胱输尿管口距离与远段输尿管直径（D/U）比值均短于成功组（p=0.004 和 p=0.006）。膀胱输尿管口距离＜7.4mm 的患者治疗失败的可能性为 81.82%。
超声测量膀胱输尿管口距离和 D/U 比值可可靠预测内镜下输尿管下注射治疗 VUR 的疗效。
