Bisignani G, Decter R M
Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, USA.
J Urol. 1997 Sep;158(3 Pt 2):1229-31. doi: 10.1097/00005392-199709000-00145.
Our aim was to assess whether a voiding cystourethrogram after uncomplicated ureteral reimplantation is necessary or cost-efficient.
We retrospectively reviewed the records of patients who underwent uncomplicated reimplantation at our institution from 1988 to 1994. We also reviewed the literature to tabulate the reflux resolution rate from all published series of more than 100 ureters reimplanted.
At our institution 119 patients (207 ureters) underwent uncomplicated reimplantation and a postoperative voiding cystourethrogram, which documented a 98.6% initial reflux resolution rate. All persistent postoperative reflux resolved spontaneously without treatment for a final resolution rate of 100%. We reviewed 1,494 abstracts using vesicoureteral reflux as a key word and found 19 series of more than 100 ureters reimplanted. The combined results of our series and those 19 from the literature revealed 3,346 patients (5,008 ureters reimplanted). The final reflux resolution rate was 98.58%. Series that included and excluded secondary vesicoureteral reflux documented final reflux resolution rates of 98.4 and 99.04%, respectively. Reflux resolved spontaneously in 85% of the ureters in which it was noted on the initial postoperative cystogram. At our institution the cost of a voiding cystourethrogram is $610 and we perform an average of approximately 20 uncomplicated reimplantations per year. In the United States there are approximately 230 pediatric urologists. If each surgeon performed 20 reimplantations per year at the same cost per voiding cystourethrogram, a cost savings of $2.8 million per year would result if the study were not performed after surgery.
In the hands of experienced pediatric urologists uncomplicated ureteral reimplantation has a success rate of 99.04%. The yield of postoperative voiding cystourethrography is exceedingly low and a cost savings of $2.8 million per year would result by omitting the postoperative voiding cystourethrogram.
我们的目的是评估在单纯输尿管再植术后进行排尿性膀胱尿道造影是否必要或具有成本效益。
我们回顾性分析了1988年至1994年在本机构接受单纯再植术的患者的记录。我们还查阅了文献，以汇总所有已发表的超过100例输尿管再植系列研究中的反流消退率。
在本机构，119例患者（207条输尿管）接受了单纯再植术及术后排尿性膀胱尿道造影，造影显示初始反流消退率为98.6%。所有术后持续性反流均未经治疗而自行消退，最终消退率为100%。我们以膀胱输尿管反流为关键词查阅了1494篇摘要，发现了19个超过100例输尿管再植的系列研究。我们的系列研究结果与文献中的19个系列研究结果相结合，共涉及3346例患者（5008条输尿管再植）。最终反流消退率为98.58%。纳入和排除继发性膀胱输尿管反流的系列研究记录的最终反流消退率分别为98.4%和99.04%。在术后首次膀胱造影中发现反流的输尿管中，85%的反流自行消退。在本机构，排尿性膀胱尿道造影的费用为610美元，我们每年平均进行约20例单纯再植术。在美国，大约有230名儿科泌尿科医生。如果每位外科医生每年进行20例再植术，且排尿性膀胱尿道造影的费用相同，那么如果术后不进行该检查，每年可节省280万美元。
在经验丰富的儿科泌尿科医生手中，单纯输尿管再植术的成功率为99.04%。术后排尿性膀胱尿道造影的阳性率极低，省略术后排尿性膀胱尿道造影每年可节省280万美元。
