Serhat GÜROCAK, Özgür TAN, İyimser ÜRE, Esat AK, Zafer SINIK, İrfan ATAY, Cenk ACAR

Revisiting the EAU Paediatric Urology Guideline Risk Grouping On Vesicoureteral Reflux: Shall We Challenge Ourselves?

Amaç: Vezikoüreteral reflüde (VUR) risk gruplaması konusundaki yeni EAU kılavuzlarına göre VUR için yaptığımız tedavilerin sonuçlarının tekrar değerlendirilmesi. Yöntem: 2009-2012 yılları arasında VUR nedeniyle medikal veya cerrahi tedavi görmüş hastaların kayıtları tekrar incelendi. Hikaye, demografik veriler, tanı esnasındaki klinik özellikler (renal skar varlığı, reflü derecesi, reflü yönü), klinik seyir, başarısızlık nedenleri, ikincil girişim tipi ve takipte elde edilen veriler değerlendirildi. EAU kılavuzlarına göre hastalar düşük, orta ve yüksek risk gruplarına ayrıldı. Tedavi başarısızlığı, yeni tanımlanan üriner sistem enfeksiyonu ve takipte yeni oluşan renal skar olarak kabul edildi. Bulgular: VUR nedeniyle 159 hastanın 232 renal ünitesi tedavi edilmişti. Primer tedavi ile elde edilen sonuçlar tablo 1'de özetlenmiştir. Düşük risk grubunda olan 46 RÜ'nün 33(%71.7)'ü subüreterik enjeksiyon ile tedavi edilmişti. Bu hastalar arasında başarısız ilk tedavi nedeniyle re-enjeksiyon yapılan 18(%39.1) hasta mevcuttu. Re-enjeksiyon yapılıp takipte yeni renal skar tespit edilen veya üriner sistem enfeksiyonu geçiren sadece 2(11.1%) hasta vardı. Orta risk grubunda ilk tedavisi başarısız olan 61 hastanın 54'ü re-enjeksiyon, 7'si üreteral reimplantasyon ile tedavi edildi. 54 hastanın 4(%7,4)'ünde takipte yeni renal skar veya üriner sistem enfeksiyonu tespit edildi. Yüksek risk grubunda ilk tedavisi başarısız olan 25 hastanın 13'ü re-enjeksiyon, 12'si üreteral re-implantasyon ile tedavi edildi. Sonuç: Düşük risk grubunda gereksiz tedavi uygulanmış olduğunu söyleyebiliriz. Orta ve yüksek risk grubu hastalarda cerrahi tedavinin başarısı daha belirgindi. Cerrah, düşük risk grubunda daha sık takip kararı vermeli, orta ve yüksek risk grubunda ise daha girişimsel davranmalıdır kanaatindeyiz.

Vezikoüreteral Reflüde Risk Gruplandırması Konusunda EAU Çocuk Ürolojisi Kılavuzlarının Yeniden Gözden Geçirilmesi: Kendimizi Sorgulamalı mıyız?

Objective: To challenge retrospectively the treatment outcomes of vesicoureteral reflux (VUR) management according to new EAU Paediatric Urology Guideline Risk Grouping on VUR. Methods: The records of the patients who received medical and/or surgical treatment between 2009-2012 due to VUR were reviewed. History, demographic variables, diagnostic features (presence of renal scar, grade of reflux, laterality), clinical course, causes of failure, secondary intervention type and follow-up variables were analyzed. The patients were classified as low, moderate and high-risk groups according to EAU paediatric urology guideline. Treatment failure is defined as new urinary tract infection and presence of new renal scar during follow-up. Results: A total of 157 patients with 232 renal units (RU) were treated due to VUR. 33(71.7%) of 46RU's were treated with sub-ureteric injection and 18(39.1%) unsuccessful RU's were treated with re-injection in low risk group. Only 2(11.1%) re-injected RU's had postoperative UTI and/or new renal scar at follow-up. In moderate risk group, 54 and 7 of 61 unsuccessful RU's were treated with re-injection and ureteral re-implantation, respectively. 4(7.4%) of 54 had postoperative UTI and/or new renal scar at follow-up. In high-risk group, 13 and 12 of 25 unsuccessful RU's treated with re-injection and ureteral reimplantation, respectively. Conclusion: We detected over treatment in low risk group. Success of the surgical correction was evident in moderate and high-risk group. The surgeon should be more pursuer in low risk and more invasive in moderate and high-risk group.

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