Mid-Term Safety and Efficacy of the Modified Double Hydrodistention Implantation Technique (HIT), Termed Systematic Multi-Site HIT (SMHIT), for Patients with Primary Vesicoureteral Reflux

Research and Reports in Urology

关键词: dextranomer hyaluronic acid;    dx/ha;    endoscopic treatment;    vesicoureteral reflux;   

DOI  :  

来源: DOAJ

【 摘 要 】

Shigeru Nakamura,1 Kazuya Tanabe,1 Taiju Hyuga,1,2 Taro Kubo,1 Satoru Inoguchi,1 Shina Kawai,1 Hideo Nakai1 1Department of Pediatric Urology, Jichi Medical University, Children’s Medical Center Tochigi, Shimotsuke, Japan; 2Department of Developmental Genetics, Institute of Advanced Medicine, Wakayama Medical University (WMU), Wakayama, JapanCorrespondence: Shigeru NakamuraDepartment of Pediatric Urology, Jichi Medical University, Children’s Medical Center, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, JapanTel [phone]Fax [phone]Email [e-mail]: To evaluate the treatment outcomes and postoperative complications associated with the systematic multi-site hydrodistention implantation technique (SMHIT) for primary vesicoureteral reflux (VUR) and to determine its mid-term efficacy and safety.Patients and Methods: We retrospectively reviewed the data for 17 ureters from 12 consecutive children, aged ≥ 1 year, with grade II–IV reflux and a history of febrile urinary tract infections (FUTI), who underwent a single-session of SMHIT. The primary outcome was the absence of postoperative FUTI (clinical success). The secondary outcome was improvement in reflux to grade 0–I on postoperative voiding cystourethrography (radiographic success).Results: Five and 7 children had bilateral and unilateral reflux, respectively. Reflux was categorized as grade II, III, and IV reflux in 2, 12, and 3 ureters, respectively. Seven of 10 (70%) toilet-trained children had bladder-bowel dysfunction (BBD) preoperatively. The SMHIT was performed for all patients, after which BBD improved. The mean postoperative follow-up period was 6 years and 9 months. The clinical success rate was 100%. Radiographic success was achieved in 16/17 ureters (94%) at 3– 4 months, 17/17 (100%) ureters at 1 year, and 17/17 (100%) ureters at 3 years postoperatively. Major complications did not develop postoperatively.Conclusion: When prioritizing treatment of concomitant BBD in children with primary VUR and avoiding dextranomer/hyaluronic acid injection therapy in contraindicated children according to the Food and Drug Administration recommendations, a single-session of SMHIT may be as effective and safe in the mid-term as performing open anti-reflux surgery.Keywords: dextranomer hyaluronic acid, Dx/HA, endoscopic treatment, vesicoureteral reflux

【 授权许可】

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