OKTAY ULUSOY, OSMAN ZEKİ KARAKUŞ, Serdar ŞIYVE, OĞUZ ATEŞ, FAİKA GÜLCE HAKGÜDER, MİRAÇ FEZA AKGÜR, MUSTAFA OLGUNER

Vezikoüreteral reflü tedavisinde subüreterik enjeksiyon tedavisi: Tek merkez deneyimi

Amaç: Vezikoüreteral reflü (VÜR) tedavisinde subüretik enjeksiyon (SE) yaygın olarak kullanılmaktadır. Bu çalışmada VÜR tanısıile SE uygulanan hastaların uzun dönemli sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Anabilim Dalı’mızda 1993-2014 yılları arasında VÜR tanısı ile SE uygulanan 156 hastanın bilgileri retrospektif olarak incelendi. Hastaların demografik özellikleri, VÜR özellikleri, tedavi başarısı ve komplikasyonlar açısından derlendi. SE tedavisinde enjeksiyon materyali üreter orifisine submukozal olarak tek noktadan uygulandı. Hastalar postoperatif 3. ayda konvansiyonel voiding sistoüretogram ya da radyonüklid işeme sistografisi ile değerlendirildi. VÜR’ü sebat eden hastalarda SE uygulaması tekrarlandı. Bulgular: VÜR saptanan 156 hastada (115 kız, 41 erkek), 222 üreter tedavi edildi. Hastaların yaş ortalaması 6,4±3,4yıl (8 ay-16 yaş) idi. SE öncesinde ürodinamide aşırı aktif mesane bulguları saptanan hastalar oksibutinin HCl ile tedavi edildi. 1993-2003 yılları arası başarı oranı %76 iken, 2003-2009 yılları arasında %83 ve 2009-2014 arasında ise %92’ye yükselmiştir. Genel başarı oranı % 86 olarak saptandı. Üçüncü ve 4. SE uygulamalarında başarı oranı ortalama %14’e idi. SE tedavisi uygulanan hastaların ortalama izlem süresi 22,2± 17,6 (2 ay-72 ay) aydı. Sonuç: VÜR tedavisinde SE uygulaması yüksek başarı ve düşük komplikasyon oranlarıyla etkin olarak kullanılmaktadır. Ancak ikinci SE uygulamasından sonra sebat eden VÜR’ler için üreteroneosistostomi uygulanması tercih edilmelidir.

Anahtar Kelimeler:

vezikoüreteral reflü, subüreterik enjeksiyon, üreteroneosistostomi, üriner sistem enfeksiyonu

Subureteric Injection In The Treatment Of Vesicoureteral Reflux: Single Center Experience

Objective: Subureteric agent injection is preferred increasingly in the treatment of vesico-ureteral reflux (VUR) disease. In this study, we aimed to evaluate the long term results of patients who had VUR disease treated with subureteric agent injection.We used radionuclide direct cystogram or conventional voiding cystography to control VUR presence at the postoperative 3rd month. Subureteric agent injection was repeated who had persistence VUR.Results: A total 222 ureter of 156 patients (115 female, 41 male) who had VUR were treated. Mean age of patients were 6.4±3.4 (8 month-16 years). Patients who had overactive bladder in urodynamic tests before using subureteric agent injection were treated with oxybutynin HCl. When the patients were evaluate between 1993-2003 years, 2003-2009 years and 2009-2014 years, we found the success rate increasing as 76%, 83% and 92%; respectively. The overall success rate was found 86%. At the third or fourth subureteric agent injections, the success rate decreased to 15%. Follow up time of the patients performed subureteric agent injections was 22.2± 17.6 (2 -72) months.Conclusion: Subureteric agent injections for VUR treatment is an effective method with high success rate and low complication rate. If VUR still exists after the second subureteric injection, ureteroneocystostomy must be preferred.

Keywords:

vesicoureteral reflux, subureteric agent injections, ureteroneocystostomy, urinary tract infection,

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