Is a secondary procedure necessary in every case of failed endoscopic treatment for vesicoureteral reflux?

Korean Journal of Urology Pub Date : 2015-05-01 Epub Date: 2015-04-24 DOI:10.4111/kju.2015.56.5.398
Hyun Jin Jung, Young Jae Im, Yong Seung Lee, Myung Joo Kim, Sang Won Han
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引用次数: 2

Abstract

Purpose: Endoscopic treatment (ET) has become a widely accepted procedure for treating vesicoureteral reflux (VUR). However, patients followed up after ET over long periods have reported persistent or recurrent VUR. We evaluated the natural course of failed ET in patients who required further treatments to help physicians in making decisions on the treatment of VUR.

Materials and methods: We retrospectively reviewed the medical records of patients who were diagnosed with VUR and underwent ET from January 2006 to December 2009. A total of 165 patients with 260 ureters underwent ET. We compared the parameters of the patients according to ET success or failure and evaluated the natural course of the patients after ET failure.

Results: Mean VUR grade and positive photon defect were higher in the failed ET group than in the successful ET group. Six months after the operation, persistent or recurrent VUR was observed in 76 ureters (29.2%), and by 16.3 months after the operation, VUR resolution was observed in 18 ureters (23.7%). Twenty-five ureters (32.9%) without complications were observed conservatively. Involuntary detrusor contraction was found in 1 of 9 (11.1%) among the secondary ET success group, whereas in the secondary ET failure group, 4 of 6 (66.7%) had accompanying involuntary detrusor contraction.

Conclusions: Patients in whom ET fails can be observed for spontaneous resolution of VUR unless they have febrile urinary tract infection or decreased renal function. Urodynamic study may be helpful in deciding whether a secondary procedure after ET failure is necessary.

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对于膀胱输尿管反流的内镜治疗失败的病例是否都需要二次手术?
目的:内镜治疗(ET)已成为一种广泛接受的治疗膀胱输尿管反流(VUR)的方法。然而,长期随访的患者报告持续性或复发性室性静脉血栓。我们评估了需要进一步治疗的患者的ET失败的自然过程,以帮助医生做出VUR治疗的决定。材料和方法:我们回顾性回顾了2006年1月至2009年12月诊断为VUR并接受ET治疗的患者的医疗记录。我们对165例输尿管260条进行了ET治疗。我们根据ET成功或失败的情况比较了患者的参数,并评估了ET失败后患者的自然病程。结果:ET失败组的平均VUR分级和正光子缺陷均高于ET成功组。术后6个月,有76条输尿管出现持续或复发性VUR(29.2%),术后16.3个月,18条输尿管VUR消退(23.7%)。保守观察输尿管25条(32.9%)无并发症。继发性ET成功组9例中有1例(11.1%)出现非自愿逼尿肌收缩,而继发性ET失败组6例中有4例(66.7%)伴有非自愿逼尿肌收缩。结论:除非有发热性尿路感染或肾功能下降,否则可以观察到ET衰竭患者自发性VUR的消退。尿动力学研究可能有助于决定是否有必要在ET衰竭后进行二次手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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