- 作者：Ali Tourchi ; Abdol-Mohammad Kajbafzadeh ; Zahra Aryan ; Maryam Ebadi
- 刊名：Urology
- 出版年：January, 2014
- 年：2014
- 卷：83
- 期：1
- 页码：199-205
- 全文大小：594 K
Objective
To represent our experience in the management of posterior urethral valves and concomitant vesicoureteral reflux (VUR).Methods
A total of 326 children with posterior urethral valve who had underwent valve ablation/bladder neck incision were studied, and those who had persistent VUR and were categorized under 3 main groups were followed up. Group 1 (n聽= 71) received prophylactic antibiotic, group 2 (n聽= 50) underwent Deflux injection (2a) (n聽= 28): Deflux injection alone, group 2b (n聽= 22) Deflux with concomitant autologous blood injection (HABIT), and group 3 (n聽= 19) underwent ureteroneocystostomy before referral and was followed up conservatively. VUR resolution, incidence of urinary tract infections (UTI), and bladder function were assessed.
Results
Mean duration of follow-up was 3.8聽years; VUR resolution occurred in 66.1%, 86.0%, and 94.0% of groups 1-3, respectively (P聽= .013). Resolution rate in group 2b was significantly higher than group 2a (90.9% vs 78.5%). Patients in group 2 experienced a longer UTI-free period compared with others (P聽<.05). Urodynamic studies demonstrated significant decrease in maximum voiding detrusor pressure and detrusor overactivity in all groups (P聽<.001). Children in group 3 ended up with lower compliance compared with others (P聽<.001). After toilet training, only 2.8%, 21.4%, 13.6%, and 27% children were diagnosed with lower urinary tract dysfunction in groups 1-3, respectively (P聽= .027). Myogenic failure developed only in 3 boys in group聽3.
Conclusion
Ablation/bladder neck incision leads to significant improvement in VUR status in part because of improvement in bladder function. After successful valve removal, conservative therapy can be regarded as the mainstay of reflux treatment, whereas HABIT is recommended for high grade VUR associated with febrile UTI or deterioration in renal function.