Vezikoüretral Reflü Tedavisi: Üreteroneosistostomi İle Endoskopik Subüreteral İnjeksiyon Sonuçlarının Karşılaştırılması

Abstract

Management of Vesicoureteral Reflux: The Comparison of the Outcomes of Ureteroneocystostomy and Endoscopic Subureteral Injections Endoscopic subureteral injection has become an established alternative to ureteroneocystostomy in the treatment of vesicoureteral reflux. The outcomes of 61 patients with VUR whom treated with either ureteroneocystostomy or endoscopic procedures were compared. Ureteroneocystostomy was perfomed in 44 refluxing ureters of 31 children, subureteral Teflon injection in 34 refluxing ureters of 20, and Silicone injection in 17 refluxing ureters of 10 children. The ages, clinical, radiological, and endoscopic findings, operation time, hospital stay of the patients and outcomes of the treatments were compared. Ages of patients ranged between 1.5 and 17 (mean 6.7) years. There were grade II reflux in 23.5%, grade III reflux in 35.3% and grade IV reflux in 41.2% of the ureters of subureteral teflon injected patients. In subureteral Silicone injected patients these rates were 17.6%, 35.3% and 47.1%, respectively. Grade III, IV and V reflux also were found in 15.9%, 45.4%, 38.7% of the ureters of ureteroneocystostomized patients, respectively. In 70.5% and 88.2% of the ureters reflux was cured after the first and second Teflon injections. These rates were found as 53% and 76.4% after the first and the second Silicone injections, respectively. The reflux was cured completely in 95.45% of the ureters of the ureteroneocystostomized patients. Mean follow-up was 18.7 (ranged 5.5 to 41) months. Mean hospital stay was found as 1 and 12 days after the injections and ureteroneocystostomy, respectively. In conclusion, although ureteroneocystostomy is the gold standard treatment for high grade refluxes, endoscopic subureteral injections may be the first choice for the treatment of moderate grade refluxes because of its non-invasiveness. Vezikoureteral reflunun (VUR) tedavisinde endoskopik subureteral injeksiyonlar ureteroneosistostomilere alternatif olmaktadir. Bu calismada ureteroneosistostomi veya subureteral injeksiyon ile tedavi edilen primer VUR'lu 61 olgunun sonuclan karsilas tini di. Ureteroneosistostomi 31 olgunun 44, endoskopik subureteral Teflon injeksiyonu 20 olgunun 34 ve Silikon injeksiyonu 10 olgunun 17 ureter birimine uygulandi. Olgularin yas dagilimi, klinik, radyolojik ve endoskopik bulgulan, anestezi ve hastanede kalis sureleri ile tedavi sonuclan karsilastinldi. Olgularin yas dagilimi 1,5 ile 17 (ortalama 6.7) yil arasinda degismekteydi. Teflon injeksiyonu yapilan olgularin sirasiyla %23.5, %35.3 ve %41.2 sinde II, III ve IV. derece reflu saptanirken, Silikon injeksiyonu yapilan olgularda bu oranlar sirasiyla %17.6, %35.3 ve %47.1 idi. Ureteroneosistostomi yapilan olgularin ise sirasiyla %15.9, %45.4 ve %38.7'sinde III, IV ve V. derece reflu vardi. Birinci Teflon ve Silikon injeksiyonlarindan sonra ureterlerin %70.5 ve %53 unde reflu onlenirken, ikinci injeksiyonlardan sonra bu oranlar sirasiyla %88.2 ve %76.4 bulundu. Buna karsin ureteroneosistostomi yapilan ureterlerin %95.45 inde reflu tamamen onlendi. Izleme sureleri 5.5 ile 41 (ortalama 18.7) ay arasinda degisen olgularin ortalama hastanede kalis sureleri ureteroneosistostomilerde 12, injeksiyonlarda 1 gun bulundu. Sonuc olarak, yuksek derece VUR nun altin standart tedavisi ureteroneosistostomidir. Endoskopik subureteral injeksiyon, non-invazif olmasi nedeniyle orta derece reflulerin tedavisinde ilk secenek olabilir.