VESCICO-URETERAL REFLUX: ENDOSCOPIC TREATMENT, MANAGEMENT AND LONG-TERM FOLLOW-UP

摘要

Introduction. Vescicoureteral reflux (VUR) is a dynamic event in which there is a retrograde passage of urine from the bladder to the ureters. It is the most common urological disease in the childhood and it manifests with recurrent urinary tract infections (UTI). The therapeutic strategy provides an antibiotic prophylaxis, invasive surgery (Cohen reimplantation) and minimally invasive surgery (endoscopic subureteral injection). Recently, Endoscopic Subureteral Injection with Deflux became the treat- ment of choice. The purpose of this work was to conduce a retrospective study of our patients with VUR to evaluate the role of endoscopic technique (Deflux and Macroplastique) in the treatment. Materials and Methods. Forty two patients with VUR were treated by us in 65 refluxing units. Twenty were males (47.6%) and 22 (52.4%) females. Sex, age of infiltration, presence of associated diseases, unilaterality and bilaterality, side of pres- entation of VUR and substance used for injection were considered. The follow-up study included urine cultures and periodic renal ultrasound. The mintional cistouretrography was performed after 12 months. The results were statistically evaluated with the "Wilcoxson test”, comparing data of patients treated with Deflux and Macroplastique. results. Refluxing ureters underwent endoscopic treatment by submeatal injection were 65, 4.6% with VUR grade I, 12.3% grade II, 43% grade III, 29.23% grade IV and 10.87% gradeV. In 19 patients, amounting to 45.2%, this was a unilateral VUR (84.2% left, 15.78% right) and in 23 patients, equal to 54.76%, a bilateral VUR. Thirdy eight per cent of these patients had associated diseases. At the first follow-up, the cure rate was 81.53%. At the second follow-up, the cure rate, including the 9 children re-infiltrated, was 89.23%. Four patients underwent a further infiltration, so as at the third follow-up, the overall cure rate was 93.84%. In only one patient with bilateral VUR grade IV, it was necessary to perform Cohen ureteral reimplan- tation due to the persistence of VUR after 2 endoscopic infiltration. In another one, due to the clinical severity and the per- sisting of VUR after two endoscopic infiltration, we decided to plan the bilateral reimplant according to Cohen. We have not been demonstrated significant differences based on gender, age of infiltration and the substance used, were not observed. Conclusions. At the moment, ours patients have a regular weight-height growth and they don’t have urinary tract infection or vescicoureteral reflux. The sub-meatal infiltration is a simple, repeatable and reliable techinique whereby results are imme- diate and safe in most cases. For this reason, we conclude that the submeatal infiltration represents the first-line treatment in patients with vescicoureteral reflux.