Nascimben Francesca, Talon Isabelle, Maldonado Consuelo, Angotti Rossella, Molinaro Francesco, Moog Raphael, Becmeur Francois
Department of Pediatric Surgery, University Hospital of Hautepierre, Strasbourg, France.
Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
Transl Androl Urol. 2024 Aug 31;13(8):1446-1454. doi: 10.21037/tau-24-76. Epub 2024 Aug 26.
Endoscopic injection (EI) is a safe treatment for vesico-ureteral reflux (VUR) in children, but recurrences are not insignificant. This study aims to show if multiple EI is still the best first line management even if in case of recurrences.
All patients affected by primary VUR, treated with at least one EI and with at least 5 years follow up were included. All general data were analyzed. Recurrence rate after one, two and three EIs were calculated.
One hundred and sixty-one patients (total number =210) were healed after 1 injection, 28 after 2 and 4 after 3 with a global success rate of 91.90%. Recurrence rate is higher in patients older than 3 years old and with IV and V reflux grade. Even if 67.7% of recurrent VUR after one injection was symptomatic, diagnosis of recurrences after multiple EI was mainly radiological. Only 8% of the patients underwent EI need an anti-reflux surgery.
Thanks to its low costs and the acceptable recurrence rate, Deflux EI should be proposed as the first therapeutic approach for children affected by VUR, especially in those with low and moderate grades of VUR. Multiple injections could be contraindicated only in older children thank 1 year with high-grade VUR (IV symptomatic and V grade).
内镜注射（EI）是治疗儿童膀胱输尿管反流（VUR）的一种安全方法，但复发情况并不少见。本研究旨在表明，即使出现复发，多次内镜注射是否仍是最佳的一线治疗方法。
纳入所有患有原发性VUR、接受过至少一次内镜注射且随访至少5年的患者。分析所有一般数据。计算一次、两次和三次内镜注射后的复发率。
161例患者（总数=210）在1次注射后治愈，28例在2次注射后治愈，4例在3次注射后治愈，总体成功率为91.90%。3岁以上且反流分级为IV级和V级的患者复发率更高。即使一次注射后67.7%的复发性VUR有症状，但多次内镜注射后复发的诊断主要依靠影像学检查。仅8%接受内镜注射的患者需要进行抗反流手术。
由于成本低且复发率可接受，Deflux内镜注射应作为VUR患儿的首选治疗方法，尤其是低级别和中级别VUR患儿。仅对于1岁以上患有高级别VUR（IV级有症状和V级）的大龄儿童，多次注射可能是禁忌的。
