Abstract
Açık cerrahi girişimlere alternatif olarak ortaya atılan endoskopik VUR tedavisi son 20 yılda giderek popülerize olmuştur. Ayaktan hasta uygulaması ile sorunsuz olarak yapılması, kullanılan materyallerin giderek daha kolay uygulanabilir olması kullanımını yaygınlaştırmaktadır. Kliniğimizde Mayıs 2000-Aralık 2006 tarihleri arasında VUR nedeni subüreterik dolgu maddesi enjeksiyonu ile tedavi edilen 32 erkek, 43 kız toplam 75 olgu geriye dönük olarak değerlendirmeye alındı. Yaşları cerrahi girişim yapıldığında 11 ay-13 yaş arasında değişen ortalama 5,4 yaşındaki olguların 25' inde (%33) bilateral VUR, 21' inde (%28) sağ VUR, 29' unda (%39) sol olmak üzere toplam 100 üreterde grade 2 ile 5 arasında değişen VUR saptanan 75 olguya ilk olarak subüreterik dolgu maddesi enjeksiyonu uygulaması yapıldı. Subüreterik dolgu maddesi enjeksiyonu grade 2 ve 3 VUR' ü olan olgularda antibiotik proflaksisine rağmen idrar yolu enfeksiyonunun tekrar etmesi nedeni ile yapılırken, grade 4 ve 5 böbrekte skar gelişmemiş olan VUR' lülü olgularda açık cerrahi girişimlere alternatif olarak gerçekleştirildi. İlk enjeksiyon sonrası 54 üreterde (43 olgu) reflü (%54) kayboldu. İyileşme görülmeyen 46 üretere (32 olguya) ikinci enjeksiyon maddesi uygulandı ve 14 üreter (11 olguda) iyileşme görüldü. Reflüsü devam eden 21 olgudan yedisi açık cerrahiye alınırken 14 olguya enjeksiyon üçüncü kez uygulandı. Bir olguda iyileşme saptanırken reflüsü gerilemeyen 13 olgu açık cerrahiye alındı. Toplam 20 olguda 31 üretere reimplantasyon uygulandı. Endoskopik enjeksiyon sonrası olguların %57' sinde ilk enjeksiyon sonrası reflünün geçtiği saptanırken üçüncü enjeksiyon sonrası bu oranın %73' e yükseldiği görüldü. Enjeksiyon sonrası sadece bir olguda 6 gün süren makroskopik hematüri saptanırken başka herhangi bir komplikasyonla karşılaşılmadı. Endoskopik VUR tedavisi düşük komplikasyon oranı ile düşük dereceli reflülerdeki yüksek başarı oranı ile VUR tedavisinde uygulanacak ilk tedavi seçeneği olarak görülmektedir
References
- PG, Woolf AS. Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: arandomised trial. Lancet 2001; 357: 1329-1333. Scherz HC. Endoscopic treatment with dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux. J Urol 2004; 172:1614 -1616.
- Weiss R, Duckett J, Spitzer A. Results of a randomized clinical trial of medical versus surgical management of infants and children with grade 3 and 4 primary vesicoureteral reflux (United States). The International Reflux Study in Children. J Urol 1992; 148: 1667-1673.
- Elder JS, Peters CA, Arant BS, Ewalt DH, Hawtrey CE, Hurwitz RS, Parrott TS, Snyder HM III, Weiss RA, Woolf SH, Hasselblad V. Pediatric vesicoureteral reflux guidelines panel. Summary report on the management of primary vesicoureteral reflux in children. J Urol 1997; 157: 1846-1851.
- Kirsch AJ, Perez-Brayfield M, Scherz HC. Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the Children's Hospitals of Atlanta experience. J Urol 2003; 170: 211-215.
- Herz D, Hafez A, Bagli D, Capolicchio G, McLorie G, Khoury A. Efficacy of endoscopic subureteral polydimethylsiloxane injection for treatment of vesicoureteral reflux in children. A North American Clinical report. J Urol 2001; 166: 1880-1886
Abstract
Endoscopic VUR treatment has been popularized during the last 20 years as an alternative to open procedures. It has been widely used since the application materials are easy to use without complication in outpatients. 32 male and 43 female patients operated for VUR during May 2000 to December 2006 at our Pediatric Surgery Clinic were evaluated retrospectively. The mean age of the patients were 5,4 years in (11 months-13 years). In 25 patients there were bilateral VUR (33%), in 21 patients there were right VUR (28%), and in 29 patients there were left VUR (39%) adding up to 100 affected ureters. Subureteral injection was performed on 75 patients as for first choice of treatment. Subureteral injections were applied to the patients with grade 2 and 3 vesicoureteral reflux in whom urinary tract infections recurred against antibiotic profilaxis whereas the procedure was realized as an alternative to open surgical approaches in patients with grade 4 and 5 vesicoureteral reflux in the abscence of renal scarring.Following the first trial of injection reflux healed in 54 ureters (43 patients 54%). A second injection was performed on 46 ureter (32 patients) whose reflux persisted after the first trial. 14 ureters (11 patients) responded well to the second application of the material. Of the 21 patients whose reflux persisted after the second endoscopic teratment seven were operated and in 14 of the patients endoscopic injection was applied for the third time. Only one patient responded well to the third injection whereas 13 of the patients were reimplanted.Following single endoscopic injection 57% of the patients with reflux were treated reaching a 73% success after a third trial of injection. Macroscopic hematuria lasting for 6 days following the injection procedure in one of the patients was the only complication encountered. Endoscopic VUR treatment seems to be the first choice of treatment in low grade reflux patients with high success and low complication rates
References
- PG, Woolf AS. Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: arandomised trial. Lancet 2001; 357: 1329-1333. Scherz HC. Endoscopic treatment with dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux. J Urol 2004; 172:1614 -1616.
- Weiss R, Duckett J, Spitzer A. Results of a randomized clinical trial of medical versus surgical management of infants and children with grade 3 and 4 primary vesicoureteral reflux (United States). The International Reflux Study in Children. J Urol 1992; 148: 1667-1673.
- Elder JS, Peters CA, Arant BS, Ewalt DH, Hawtrey CE, Hurwitz RS, Parrott TS, Snyder HM III, Weiss RA, Woolf SH, Hasselblad V. Pediatric vesicoureteral reflux guidelines panel. Summary report on the management of primary vesicoureteral reflux in children. J Urol 1997; 157: 1846-1851.
- Kirsch AJ, Perez-Brayfield M, Scherz HC. Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the Children's Hospitals of Atlanta experience. J Urol 2003; 170: 211-215.
- Herz D, Hafez A, Bagli D, Capolicchio G, McLorie G, Khoury A. Efficacy of endoscopic subureteral polydimethylsiloxane injection for treatment of vesicoureteral reflux in children. A North American Clinical report. J Urol 2001; 166: 1880-1886
Details
| Other ID | JA56FD97AA |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | June 1, 2007 |
| Submission Date | June 1, 2007 |
| Published in Issue | Year 2007 Volume: 1 Issue: 1 |
The publication language of Turkish Journal of Pediatric Disease is English.
Manuscripts submitted to the Turkish Journal of Pediatric Disease will go through a double-blind peer-review process. Each submission will be reviewed by at least two external, independent peer reviewers who are experts in the field, in order to ensure an unbiased evaluation process. The editorial board will invite an external and independent editor to manage the evaluation processes of manuscripts submitted by editors or by the editorial board members of the journal. The Editor in Chief is the final authority in the decision-making process for all submissions. Articles accepted for publication in the Turkish Journal of Pediatrics are put in the order of publication, with at least 10 original articles in each issue, taking into account the acceptance dates. If the articles sent to the reviewers for evaluation are assessed as a senior for publication by the reviewers, the section editor and the editor considering all aspects (originality, high scientific quality and citation potential), it receives publication priority in addition to the articles assigned for the next issue.
The aim of the Turkish Journal of Pediatrics is to publish high-quality original research articles that will contribute to the international literature in the field of general pediatric health and diseases and its sub-branches. It also publishes editorial opinions, letters to the editor, reviews, case reports, book reviews, comments on previously published articles, meeting and conference proceedings, announcements, and biography. In addition to the field of child health and diseases, the journal also includes articles prepared in fields such as surgery, dentistry, public health, nutrition and dietetics, social services, human genetics, basic sciences, psychology, psychiatry, educational sciences, sociology and nursing, provided that they are related to this field. can be published.