CHU de Rouen, Department of Pediatric and Adolescent Surgery, 76000 Rouen, France.
CHU de Rouen, Department of Pediatric and Adolescent Surgery, 76000 Rouen, France.
Fr J Urol. 2024 Mar;34(2):102585. doi: 10.1016/j.fjurol.2024.102585. Epub 2024 Feb 6.
The aim was to compare the efficacy of polyacrylate polyalcohol copolymer (PPC) injections and dextranomer/hyaluronic acid (Dx/Ha) injections for the endoscopic treatment of vesicoureteral reflux in children.
This retrospective cohort study included 189 young patients who had endoscopic treatment for vesicoureteral reflux from January 2012 to December 2019 in our center. Among them, 101 had PCC injections and 88 had Dx/Ha injections. Indications for treatment were vesicoureteral reflux with breakthrough urinary tract infection or vesicoureteral reflux with renal scarring on dimercaptosuccinic acid (DMSA) renal scan. Endoscopic injection was performed under the ureteral meatus. Early complications, recurrence of febrile urinary tract infection and vesicoureteral reflux after endoscopic injection, ureteral obstruction and reintervention were evaluated and compared between groups.
Endoscopic treatment was successful in 90.1% of patients who had PPC injection and in 82% of patients who had Dx/Ha injection. Four patients presented a chronic ureteral obstruction after PPC injection, one with a complete loss of function of the dilated kidney. One patient in the Dx/Ha group presented a postoperative ureteral dilatation after 2 injections.
Despite a similar success rate after PPC and Dx/Ha injections for endoscopic treatment of VUR, there may be a greater risk of postoperative ureteral obstruction after PPC injections. The benefit of using PPC to prevent febrile UTI and renal scarring in children with low-grade VUR does not seem to outweigh the risk of chronic ureteral obstruction.
目的是比较聚丙烯酸聚醇共聚物（PPC）注射剂和葡聚糖/透明质酸（Dx/Ha）注射剂在儿童膀胱输尿管反流内镜治疗中的疗效。
本回顾性队列研究纳入了 2012 年 1 月至 2019 年 12 月在我中心接受内镜治疗膀胱输尿管反流的 189 名年轻患者。其中 101 例接受 PPC 注射，88 例接受 Dx/Ha 注射。治疗指征为有突破感染性尿路感染或二巯丁二酸（DMSA）肾扫描有肾瘢痕的膀胱输尿管反流。内镜注射在输尿管口进行。评估并比较两组间的早期并发症、内镜注射后发热性尿路感染和膀胱输尿管反流复发、输尿管梗阻和再次干预情况。
接受 PPC 注射的患者中，内镜治疗成功率为 90.1%，接受 Dx/Ha 注射的患者中，内镜治疗成功率为 82%。4 例 PPC 注射后出现慢性输尿管梗阻，1 例扩张肾完全丧失功能。1 例 Dx/Ha 组患者在 2 次注射后出现术后输尿管扩张。
尽管 PPC 和 Dx/Ha 注射治疗 VUR 的成功率相似，但 PPC 注射后发生术后输尿管梗阻的风险可能更高。在低级别 VUR 儿童中使用 PPC 预防发热性尿路感染和肾瘢痕的益处似乎并不超过慢性输尿管梗阻的风险。
