Primer vezikoüreteral reflünün tedavisinde endoskopik subüreteral kollajen enjeksiyonunun uzun dönem etkinliği
Primer vezikoüreteral reflünün (VUR) tedavisinde subüreteral kollajen enjeksiyonunun uzun dönem etkinliğini retrospektif olarak değerlendirdik. Toplam 32 renal ünite subüreteral kollajen enjeksiyonu ile tedavi edildi. Grade 1, 4 ve 5 reflülü ve ciddi alt üriner sistem disfonksiyonlu hastalar çalışma dışı bırakıldı. Tek enjeksiyon sonrası 1. ayda halen reflüsü devam eden hastalar dışlandıktan sonra, 36 ay takibi tamamlayan 32 renal ünite çalışmaya dahil edilmiştir. 6. ayda 32 renal üniteden 21'inde (%65.6) reflü yoktu. Tek enjeksiyon ve bir kez tekrarlanan enjeksiyon sonrası sırasıyla, 12 ay takipte 18 (%56.2) ve 22 (%68.7) renal ünitede halen reflü yoktu; 24 ay takipte 14 (%43.7) ve 17 (%53.1) renal ünitede reflü görülmedi. 36 aylık takiplerini tamamlayan reflülü 32 renal üniteli hastada tek enjeksiyon sonrası total kür oranı %31.2'dir (32 renal üniteden 10'u). Bir kez tekrarlanan enjeksiyon sonrası bu oran %40.6'dır (32 renal üniteden 13'ü). 36 aylık takip sonunda toplam 19 üretere reimplantasyon yapılmıştır. Kollajen enjeksiyonun uzun dönem takipte etkisiz olduğunu düşünmekteyiz. Bu yönteminin uzun dönem için etkinliğini belirlemede daha fazla sayıda çalışmaya ihtiyaç vardır. Ayrıca uzun dönem takipte, daha çok VCUG'lar ve eğer reflü tespit edilirse tekrarlayan enjeksiyonlar için daha fazla anestezi gerekecektir.
The long term effectiveness of endoscopic subureteral collagen injection in the treatment of primary vesicoureteral reflux
We retrospectively evaluated the long-term effectiveness of the subureteral collagen injection in the treatment of vesicoureteral reflux (VUR). A total of 32 renal units were treated with subureteric collagen injection. Patients with grade 1, 4 and 5 reflux and severe lower urinary tract dysfunctions, were excluded from the study. After excluding the patients who still had reflux at 1-month follow-up after single injection, 32 renal units with complete 36-month follow-up were included into the study. At 6 months there was no reflux in 21 of 32 (65.6%) renal units. At 12 months follow-up, there was still no reflux in 18 (56.2%) and 22 (68.7%) renal units; at 24 months follow- up, 14 (43.7%) and 17 (53.1%) renal units showed no reflux after single injection and one re-injection, respectively. In patients with 32 refluxing renal units, who completed their 36 months follow-up, overall cure rate of after single injection were 31.2% (10 out of 32 renal units). This rate was 40.6% (13 out of 32 renal units) after 1 repeat injection. A total of 19 ureter had been re-implanted at the end of 36 months follow-up. We think that, collagen injection is ineffective in the longterm follow-up. Further studies are needed to determine the effectiveness of this method for long term. Furthermore, in the long term follow-up, more VCUG's and if reflux is found more anesthesia will be needed for repeat injections.
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- Başlangıç: 1947
- Yayıncı: Erkan Mor
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