Vezikoüreteral Reflü Tedavisinde Subüreteral Enjeksiyon Uygulamasinin Etkinliginin Prospektif Arastirilmasi
Prospective Evaluation of the Efficacy of Subureteral Injection in the  Management of Vesicoureteral Reflux
Yazar: Çam, H Kamil; Kayıkçı, M Ali; Akman, R Yavuz
Dergi: Duzce Medical Journal, Vol. 9 No. 3, 0
Anahtar kelimeler: Vesicoureteral reflux (VUR),dextranomer ; Vezikoüreteral reflü (VUR),dextranomer

Vezikoüreteral reflünün (VÜR) cerrahi tedavisinde son yillarda özellikle medikal tedaviye alternatif olara k gündeme gelmesi nedeniyle endoskopik subüreteral enjeksiyon giderek önem kazanmaktadir. Bu çalismada dextranomer enjeksiyonu ile endoskopik tedavi uygulanan VÜR hastalarinda tedavi basarisinin prospektif olarak degerlendirilmesi amaçlandi.  Miksiyonsistoüretragrafi (MSÜG) sonucunda VÜR tanisi konmus olan ve endoskopik tedavi uygun görülen toplam 22 hasta (27 renal ünite) çalismaya alindi. Sekonder VÜR vakalari çalismaya dahil edilmedi. Çalismaya alinan hastalarda MÜSG degerlendirmesinde 5 ünitede grade II (2 hastada bilateral VÜR), 19 ünitede grade III (3 hastada bilateral VÜR), 3 ünitede de grade IV reflü izlendi. Tüm vakalarda enjeksiyon maddesi olarak dextranomer (deflux) kullanildi. Islem sirasinda üreter orifisinden saat 6 hizasinda enjeksiyon ignesi 0,8cm kadar ilerletilerek volkan görünümünün elde edilmesi amaçlandi. Tedavi etkinligi postoperatif 3. aydaki MSÜG tetkikinde reflü olmamasi olarak kabul edildi. Postoperatif 3. ayda yapilan kontrol MSÜG’de 27 renal ünitede %81 (22/27), hasta bazinda da %77 (17/22) basari saptandi. Reflü derecesine göre basarilar grade II reflüde %80 (4/5 renal ünite), grade III reflülerde %84 (16/19 renal ünite), grade IV reflüde %66 (2/ 3 renal ünite) olarak saptandi. Sonuç olarak endoskopik subüreteral dextranomer tedavisi iyi seçilmis VÜR vakalarinda yüksek basari oranlarina sahiptir

Endoscopic subureteral injection constitutes a valuable treatment option in the surgical management of vesicoureteral reflux (VUR). Recently, it regains popularity as it has been proposed an alternative to conservative management of VUR. The objective of the current study was to prospectively evaluate the efficiency of subueretal dextranomer in jection in VUR. Twenty-two patients (27 renal units) with vesicoureteral reflux scheduled for endoscopic treatment were included in the study. Secondary reflux cases were excluded. Of the patients included in the study, grade II reflux in 5 units (bilateral reflux in two cases), grade III reflux in 19 renal units (bilateral reflux in 3), grade IV reflux in 3 units were noted. Dextranomer (deflux) was used in all the cases as bulking agent. Injection needle was introduced at six o’clock position at the ureteral orifice and further moved for 0.8 cm before injection. Injection was continued until volcanic appearance of the orifice was obtained. Success was defined as no reflux in the voiding cystourethrography obtained 3 months after the operation. Postoperative control cystourethrography showed no reflux in 22 renal units of 27 (81%), the success was 77% (17/22) when the number of the patients taken into consideration. Grade II, grade III, and grade IV refluxes resolved in 80% (4/5 renal units), 84% (16/19 renal units), 66% (2/3 renal units) respectively. We concluded that endoscopic suburethral dextranomer treatment has high success rates in the treatment of VUR for properly selected cases