Abstract
Vesicoureteral reflux is the most common urological disease in children population. The aim of this study was to show advantages and disadvantages of various bulking agents that were used in endoscopic correction of vesicoureteral reflux and to show the results achieved in University children's hospital. In this retrospective study data from 50 patients that were treated in 2 years period were analyzed. Several physicians used Deflux injection. The results of this study were compared with a previous study performed in the same study centre that was marked as the standard one. Cure rate after the first injection was 84,8%, an additional 7,6% ureteral units were downgraded and didn't need further treatment, which gives an overall success rate of 92,4% after a single injection. A second injection raised the cure rate to 96, 2%. Open surgery was performed in only 3 (3.8%) cases. We didn't have complications in the form of ureterovesical junction obstruction. Compared to the standard study we achieved similar success. Deflux injection is safe and effective and endoscopic treatment is definitely a feasible procedure. The only thing that remains is to find the bulking agent that will be more effective and safe.
Highlights
Posle drugog ubrizgavanja iščezao je refluks kod još 3 (3.8%) ureteralne jedinice
Ovaj način lečenja je bio neuspešan u 3 (3.8%) slučaja, i tada je bio urađen klasičan hirurški zahvat, tj. otvorena ureterocistoneostomija
Period praćenja u ovoj studiji je bio od samo dva meseca do 18 meseci, sa preko 60% dece koja su praćena 18 meseci
Summary
Vezikoureteralni refluks (VUR) predstavlja poremećaj kod koga postoji retrogradni tok urina iz bešike u gornje partije urotrakta, a nastaje kao posledica abnormalnosti/inkompetencije ureterovezikalnog (UV) spoja kao inače normalnog antirefluksnog mehanizma. VUR je čak i do 8 puta češći kod devojčica (3). Bez obzira što je VUR češći kod devojčica, dečaci sa UI će pre imati refluks nego devojčice sa UI, i to u odnosu 29% prema 14% (2). Odavno je poznata činjenica da se VUR javlja često među srodnicima, ali način nasleđivanja se još ne zna pouzdano. Među braćom i sestrama deteta sa VURom, VUR se javlja u 27.4% (raspon 3% do 50%), dok potomci nekog od roditelja sa VURom imaju veću incidencu do 35.7%. Prvi autor koji je opisao subureteralnu injekcionu tehniku u cilju lečenja refluksa kod odraslih bio je Matouschek 1981. Godine daju sledeće preporuke [2]: bez obzira na gradus refluksa, simptome i bubrežno ožiljavanje svaki dijagnostikovani refluks kod dece unutar prve godine života treba lečiti kontinuiranom antibiotskom profilaksom. Ciljevi ovog istraživanja bili su da se ispita uspešnost endoskopskog lečenja vezikoureteralnog refluksa Defluks pastom, i da se uporede dobijeni rezultati sa rezultatima referentne studije
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