Childhood Kidney Diseases

  • 제19권1호
  • /
  • Pages.31-38
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  • 2015
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  • 2384-0242(pISSN)
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  • 2384-0250(eISSN)
대한소아신장학회 (Korean Society of Pediatric Nephrology)
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Long-term Results of Endoscopic Deflux$^{(R)}$ Injection for Vesicoureteral Reflux in Children

  • Kim, Hwanik (Department of Urology, Seoul National University College of Medicine) ;
  • Kim, Byung Soo (Department of Urology, Seoul National University College of Medicine) ;
  • Cheong, Hae Il (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Cho, Byoung Soo (Department of Pediatrics, School of Medicine, Kyung Hee University) ;
  • Kim, Kwang Myeong (Department of Urology, Seoul National University College of Medicine)
  • 투고 : 2015.03.31
  • 심사 : 2015.04.25
  • 발행 : 2015.04.30
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초록

Purpose: We evaluated the long-term results of endoscopic Deflux$^{(R)}$ injection for treating vesicoureteral reflux (VUR) in children. Methods: Between September 2004 and September 2014, 243 children (137 boys and 106 girls) with a mean age of 53 months underwent Deflux$^{(R)}$ injection. Our clinical protocol included radionuclide voiding cystography (RNC) at postoperative 3 months, 1 year and 3 years to assess the VUR resolution. Results: The cure rates at 3 months, 1 year, and 3 years by patients were 70.8%, 64.3%, and 65.6% for the total patients and 79.2%, 75.2%, and 76.4%, for the ureters, respectively. The recurrence rate of postoperative febrile urinary tract infection (UTI) was 20% in patients without VUR at postoperative 1 year. Twenty patients undergoing ureteroneocystostomy (UNC) significantly had younger age (P=0.003), higher VUR grade (P<0.001), and lower success rates of Deflux$^{(R)}$ injection (P<0.05). On univariate analysis, older age (P=0.014) and lower grade of VUR (P=0.031) were the significant predictors of a successful outcome. But there was none on multivariate analysis. Younger age, especially age of 0-12 month-old, was the only significant predictor of postoperative febrile UTI recurrence on both univariate and multivariate analysis. Conclusion: Deflux$^{(R)}$ injection is efficacious with a low complication rate for the anti-reflux procedure in children. There is low recurrence rate of UTI though VUR persists, and high probability of no VUR at 3 years if no VUR at 1 year. It is recommendable not to perform follow-up RNC at 3 years routinely if no VUR at 1 year.

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참고문헌

  1. Smellie JM, Barratt TM, Chantler C, Gordon I, Prescod NP, Ransley PG, et al. Medical versus surgical treatment in children with severe bilateral vesicoureteral reflux and bilateral nephropathy: a randomised trial. Lancet 2001;357:1329-33. https://doi.org/10.1016/S0140-6736(00)04520-7
  2. Jacobson SH, Hansson S, Jakobsson B. Vesico-ureteric reflux: occurrence and long-term risks. Acta Paediatr suppl 1999:22-30.
  3. Matouschek E. Treatment of vesicorenal reflux by transurethral Teflon-injection. Urologe A 1981:263-4.
  4. O'Donnell B, Puri P. Treatment of vesicoureteric reflux by endoscopic injection of Teflon. J Urol 2002;167:1808-9; discussion 1810. https://doi.org/10.1016/S0022-5347(05)65234-2
  5. Dodat H, Aubert D, Chavrier Y, Geiss S, Guys JM, Lacombe A, et al., Vesicoureteric reflux in children: long-term results of endoscopic treatment by Macroplastique injection. Prog Urol 2004;14:380-4.
  6. Kirsch AJ, Perez-Brayfield M, Smith EA, Scherz HC. The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol 2004;171:2413-6. https://doi.org/10.1097/01.ju.0000127754.79866.7f
  7. van Capelle JW1, de Haan T, El Sayed W, Azmy A. Azmy, The longterm outcome of the endoscopic subureteric implantation of polydimethylsiloxane for treating vesico-ureteric reflux in children: a retrospective analysis of the first 195 consecutive patients in two European centres. BJU Int 2004;94:1348-51. https://doi.org/10.1111/j.1464-410X.2004.05172.x
  8. Stenberg A, Lackgren G. A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results. J Urol 1995;154:800-3. https://doi.org/10.1016/S0022-5347(01)67168-4
  9. Puri P, Chertin B, Murugesh V, Dass L, Colhoun E. Treatment of vesicoureteral reflux by endoscopic injection of dextranomer/hyaluronic acid copolymer (Deflux): preliminary results. J Urol 2003;170:1541-4. https://doi.org/10.1097/01.ju.0000083924.44779.80
  10. Chertin B, Colhoun E, Velayudham M, Puri P. Endoscopic treatment of vesicoureteral reflux: 11 to 17 years of followup. J Urol 2002;167:1443-6. https://doi.org/10.1016/S0022-5347(05)65340-2
  11. Routh JC, Vandersteen DR, Pfefferle H, Wolpert JJ, Reinberg Y. Single center experience with endoscopic management of vesicoureteral reflux in children. J Urol 2006;175:1889-92. https://doi.org/10.1016/S0022-5347(05)00926-2
  12. Park, Y, Kim, G. Dextranomer/hyaluronic acid copolymer $(Deflux^{(R)})$ injection for vesicoureteral reflux in children: The efficacy and safety. KJU 2007;48:620-6.
  13. Capozza N, Caione P. Dextranomer/hyaluronic acid copolymer implantation for vesico-ureteral reflux: a randomized comparison with antibiotic prophylaxis. J Pediatr 2002;140:230-4. https://doi.org/10.1067/mpd.2002.121380
  14. Elder JS, Diaz M, Caldamone AA, Cendron M, Greenfield S, Hurwitz R, et al. Endoscopic therapy for vesicoureteral reflux: a metaanalysis. I. Reflux resolution and urinary tract infection. J Urol 2006;175:716-22. https://doi.org/10.1016/S0022-5347(05)00210-7
  15. Puri P, Chertin B, Velayudham M, Dass L, Colhoun E. Treatment of vesicoureteral reflux by endoscopic injection of dextranomer/hyaluronic acid copolymer: preliminary results. J Urol 2003;170:1541-4. https://doi.org/10.1097/01.ju.0000083924.44779.80
  16. Al-Hunayan AA, Kehinde EO, Elsalam MA, Al-Mukhtar RS. Outcome of endoscopic treatment for vesicoureteral reflux in children using polydimethylsiloxane. J Urol 2002;168:2181-3. https://doi.org/10.1016/S0022-5347(05)64349-2
  17. Lackgren G, Wahlin N, Skoldenberg E, Stenberg A. Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol 2001;166:1887-92. https://doi.org/10.1016/S0022-5347(05)65713-8
  18. Lee EK, Gatti JM, DeMarco RT, Murphy JP. Long-term followup of dextranomer/hyaluronic acid injection for vesicoureteral reflux: late failure warrants continued follow-up. J Urol 2009;181:1869-74. https://doi.org/10.1016/j.juro.2008.12.005
  19. Schmedding A, Zeeh U, Huebner U, Krause M, Lorenz C. Sx INprospective multicenter survey of subureteral injection in children. Presented at International Conference on VUR in Children, Goteborg, Sweden, 4-6 June 2009.
  20. Puri P, Kutasy B, Colhoun E, Hunziker M. Single center experience with endoscopic subureteral dextranomer/hyaluronic Acid injection as first line treatment in 1,551 children with intermediate and high grade vesicoureteral reflux. J Urol 2012;188(4 Suppl):1485-9. https://doi.org/10.1016/j.juro.2012.02.023
  21. Kajbafzadeh A, Tourchi A, Aryan Z. Factors that impact the outcome of endoscopic correction of vesicoureteral reflux : a multivariate analysis. Int Urol Nephrol 2013;45:1-9. https://doi.org/10.1007/s11255-012-0327-5
  22. Stredele RJF, Dietz HG, Stehr M. Long-term results of endoscopic treatment of vesicoureteral reflux in children : Comparison of different bulking agents. J Pediatr Urol 2013;9:71-7. https://doi.org/10.1016/j.jpurol.2011.12.004
  23. Baek M, Kang MY, Lee HE, Park K, Choi H Clinical value of persistent but downgraded vesicoureteral reflux after Dextranomer/Hyaluronic acid injection in children. J Korean Med Sci 2013;28:1060-4. https://doi.org/10.3346/jkms.2013.28.7.1060
  24. Keren R, Carpenter MA, et al. Rationale and Design Issues of the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) Study Pediatrics 2008;122:240-50. https://doi.org/10.1542/peds.2008-1285D

피인용 문헌

  1. Mid-Term Safety and Efficacy of the Modified Double Hydrodistention Implantation Technique (HIT), Termed Systematic Multi-Site HIT (SMHIT), for Patients with Primary Vesicoureteral Reflux vol.12, pp.None, 2015, https://doi.org/10.2147/rru.s279240