Subureteric Injection In The Treatment Of Vesicoureteral Reflux: Single Center Experience

Year 2017, Volume: 31 Issue: 1, 1 - 7, 26.05.2017

Serdar Şıvye Osman Zeki Karakuş Oğuz Ateş , Gülce Hakgüder Feza Miraç Akgür Mustafa Olguner

Abstract

Objective: Subureteric agent injection is preferred increasingly
in the treatment of vesico-ureteral reflux (VUR) disease. In this study, we
aimed to evaluate the long term results of patients who had VUR disease treated
with subureteric agent injection.

We
used radionuclide direct cystogram or conventional voiding cystography to
control VUR presence at the postoperative 3rd month. Subureteric agent
injection was repeated who had persistence VUR.

Results: A total 222 ureter of
156 patients (115 female, 41 male) who had VUR were treated. Mean age of
patients were 6.4±3.4 (8 month-16 years). Patients who had overactive bladder
in urodynamic tests before using subureteric agent injection were treated with
oxybutynin HCl. When the patients were evaluate between 1993-2003 years,
2003-2009 years and 2009-2014 years, we found the success rate increasing as
76%, 83% and 92%; respectively. The overall success rate was found 86%. At the
third or fourth subureteric agent injections, the success rate decreased to
15%. Follow up time of the patients performed subureteric agent injections was
22.2± 17.6 (2 -72) months.

Conclusion: Subureteric agent injections for VUR
treatment is an effective method with high success rate and low complication
rate. If VUR still exists after the second subureteric injection,
ureteroneocystostomy must be preferred.

Keywords

vesicoureteral reflux, subureteric agent injections, ureteroneocystostomy, urinary tract infection

Vezikoüreteral reflü tedavisinde subüreterik enjeksiyon tedavisi: Tek merkez deneyimi

Abstract

Amaç:
Vezikoüreteral reflü (VÜR) tedavisinde subüretik enjeksiyon (SE) yaygın olarak
kullanılmaktadır. Bu çalışmada VÜR tanısıile SE uygulanan hastaların uzun
dönemli sonuçlarının değerlendirilmesi amaçlanmıştır.

Gereç
ve yöntem: Anabilim Dalı’mızda 1993-2014 yılları arasında VÜR
tanısı ile SE uygulanan 156 hastanın bilgileri retrospektif olarak incelendi.
Hastaların demografik özellikleri, VÜR özellikleri, tedavi başarısı ve
komplikasyonlar açısından derlendi. SE tedavisinde enjeksiyon materyali üreter
orifisine submukozal olarak tek noktadan uygulandı. Hastalar postoperatif 3.
ayda konvansiyonel voiding sistoüretogram ya da radyonüklid işeme sistografisi
ile değerlendirildi. VÜR’ü sebat eden hastalarda SE uygulaması tekrarlandı.

Bulgular: VÜR saptanan 156
hastada (115 kız, 41 erkek), 222 üreter tedavi edildi. Hastaların yaş
ortalaması 6,4±3,4yıl (8 ay-16 yaş) idi. SE öncesinde ürodinamide aşırı aktif
mesane bulguları saptanan hastalar oksibutinin HCl ile tedavi edildi. 1993-2003
yılları arası başarı oranı %76 iken, 2003-2009 yılları arasında %83 ve 2009-2014
arasında ise %92’ye yükselmiştir. Genel başarı oranı % 86 olarak saptandı.
Üçüncü ve 4. SE uygulamalarında başarı oranı ortalama %14’e idi. SE tedavisi
uygulanan hastaların ortalama izlem süresi 22,2± 17,6 (2 ay-72 ay) aydı.

Sonuç: VÜR tedavisinde SE uygulaması yüksek başarı
ve düşük komplikasyon oranlarıyla etkin olarak kullanılmaktadır. Ancak ikinci
SE uygulamasından sonra sebat eden VÜR’ler için üreteroneosistostomi
uygulanması tercih edilmelidir.

Keywords

vezikoüreteral reflü, subüreterik enjeksiyon, üreteroneosistostomi, üriner sistem enfeksiyonu

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