- 作者：Jonathan D. Kaye ; Arun K. Srinivasan ; Christina Delaney ; Wolfgang H. Cerwinka ; James M. Elmore ; Hal C. Scherz ; Andrew J. Kirsch ; akirschmd@aol.com
- 关键词：Deflux ; Vesico-ureteral reflux ; Success ; VCUG
- 刊名：Journal of Pediatric Urology
- 出版年：2012
- 期刊代码：191_14775131
- 类别：med
- 出版时间：June, 2012
- 卷：8
- 期：3
- 页码：297-303
- 文件大小：278 K
Objective
Criteria for success following endoscopic vesicoureteral reflux (VUR) surgery vary greatly. We sought to define outcomes based on radiographic and long-term clinical follow up.Methods
We reviewed the charts and interviewed parents of children who underwent endoscopic treatment for primary VUR (grades I-IV). All patients had a postoperative voiding cystourethrogram (VCUG) at mean of 3 months (1-21 months) and all cases of postoperative febrile urinary tract infection (FUTI) prompted repeat VCUG. Radiographic success was defined as no VUR on postoperative VCUG and clinical success as no FUTIs during follow up of 12-36聽months. To demonstrate how criteria for success can affect outcomes, we calculated the success rates using different definitions.
Results
In 2004-2008, 336 patients (296 female and 40 male, mean age 4 years) were treated with dextranomer/hyaluronic acid via the Double-HIT method. Initial radiographic success was 90%(302/336). Of these, 19 (6%) developed FUTIs, 12 (4%) of whom had recurrent VUR, and 5聽(2%) went on to open surgery. Of the radiographic failures, 18%were observed with no further treatment. Success defined clinically was 94%(281/300), and as 鈥榬adiographic cure and no clinical evidence of FUTIs鈥?it was 82%(275/336).
Conclusions
It is important to agree on a universal definition of success for VUR interventions to compare across studies and across therapies. Clinical success is more meaningful to the patient, and initial radiographic success could be followed by UTI necessitating further intervention. We question the need for routine postoperative VCUG.