Reunanen M
Department of Pediatric Surgery, Turku University Central Hospital, Finland.
Eur Urol. 1997;31(2):243-5. doi: 10.1159/000474458.
The aim of this prospective study was to investigate whether it is possible, by endoscopic collagen injection, to treat vesicoureteral reflux in children with reflux into a totally duplicated ureter system.
For more than 7 years a prospective study has been in progress on children with grade III or IV reflux (international grading). Injections were made through a pediatric cytoscope, submucosally beneath the refluxing ureteral orifice. 0.2-1.5 ml collagen was injected. Reflux was controlled with direct radionuclide cystography 1 month later. Injections were repeated once or twice (within 3 months from the first injection) if reflux persisted. Additional controls with direct radionuclide cystography were made 6 months and 2 and 4 years later.
Up to now, 24 children (27 ureter units) with reflux to a totally duplicated ureter have been treated. After 1 month, 11 out of 24 children were free from reflux; after 6 months only 6 out of 24, after 2 years only 5 out of 23, and after 4 years only 3 out of 13 children were free from the disorder. There was no statistical difference between 1-month, 6-month, 2-year, and 4-year follow-up results. The differences among children with duplicated and single ureters at each control visit were statistically highly significant. There was no significant difference between results in grade III and IV reflux. We had to treat the reflux operatively (Cohen) in 20 of these 24 children (83%).
Most of the children with reflux into a duplicated ureter system cannot be cured by endoscopic collagen injection.
本前瞻性研究旨在探讨通过内镜下注射胶原蛋白治疗完全重复输尿管系统患儿的膀胱输尿管反流是否可行。
对III级或IV级反流（国际分级）患儿进行了为期7年多的前瞻性研究。通过小儿膀胱镜在反流输尿管口下方黏膜下注射。注射0.2 - 1.5毫升胶原蛋白。1个月后用直接放射性核素膀胱造影控制反流情况。如果反流持续存在，则在首次注射后3个月内重复注射一到两次。在6个月、2年和4年后进行额外的直接放射性核素膀胱造影对照检查。
到目前为止，已对24名完全重复输尿管反流患儿（27个输尿管单位）进行了治疗。1个月后，24名患儿中有11名无反流；6个月后，24名中只有6名，2年后，23名中只有5名，4年后，13名中只有3名无此病症。1个月、6个月、2年和4年的随访结果之间无统计学差异。每次对照检查时，重复输尿管和单一输尿管患儿之间的差异具有高度统计学意义。III级和IV级反流的结果之间无显著差异。在这24名患儿中，有20名（83%）我们不得不通过手术（科恩手术）治疗反流。
大多数完全重复输尿管系统反流的患儿不能通过内镜下注射胶原蛋白治愈。
