Antenatal Hidronefroz Bulgusu ile Tanı Konulan Primer Vezikoüreteral Reflülü Olgularda Cerrahi Tedavi

Amaç: Antenatal hidronefroz (AH) nedeni ile takip edilen olguların yaklaşık %10-20'sinde vezikoureteral reflü (VUR) saptanabilir. Çalışmada AH bulgusu ile primer VUR tanısı alan olgularda tedavi ve izlem sonuçlarımızı literatür bilgileri ışığında tartışmayı amaçladık.Gereç ve Yöntemler: Kliniğimizde Mayıs 2006 - Haziran 2013 tarihleri arasında AH nedeniyle araştırılırken primer VUR tanısı alan 21 olgu (36 böbrek üreter birimi) retrospektif olarak incelendi. Yaş, cinsiyet, VUR ve hidronefroz derecesi kaydedildi. Proflaktik anitbiotik kullanma süreleri, erkek olguların sünnetli olup olmadığı hastane kaynaklarından ve ailelerden öğrenildi. Hastalar ilk girişim olarak Üreteroneosistostomi (UNC) yapılanlar, ilk girişim olarak Subüreterik materyal enjeksiyonu (STING) yapılanlar ve UNC sonrası STING yapılanlar olarak 3 gruba ayrıldı. Bulgular: AH tanısı sonrası primer VUR saptanan üçü kız (%14.3), on sekizi erkek (%85.7) toplam 21 olgu değerlendirmeye alındı. Olguların 15'inde (%71.4) reflü bilateraldi, 4'ünde (%19.1) sol, 2'sinde (%9.5) sağ üreterdeydi. İkinci derece reflü 1 (%2.7) , üçüncü derece reflü 6 (%16.6), dördüncü derece reflü 6 (%16.6), beşinci derece reflü 23 (%63.8) üreterde bulunmaktaydı. 32 böbrek üreter birimine ilk işlem olarak STING uygulandı.4 böbrek üreter birimine ise UNC yapıldı. STING sonrası 19 hastadan 8'inde İYE'nin devam ettiği görüldü. STING uygulanan 18 erkek olgudan 14'üne eş zamanlı sünnet uygulandı. Bunların 10'unda İYE'nin sünnet sonrası ortadan kalktığı görüldü. 36 böbrek üreter biriminden 14'ünün (%38,8) STING ile, 18'inin ise (%50) UNC ile iyileştiği tespit edildi. Cerrahi tedavi başarı oranının %88.8 olduğu görüldü. Sonuç: Antenatal hidronefroz bulgusu ile saptanan VUR' lu olguların genelde yüksek dereceli olduğu ve böbrek fonksiyonları düşük olduğu görüldü. Tanı anında böbrek fonksiyonlarının belirgin olarak etkilenmiş olması, antenatal dönemde böbreklerde displazi geliştiğinin kanıtı olarak görülmektedir.

Antenatal Hydronephrosis: Evaluation of 21 Cases Surgical Treatment of Vesicoureteral Reflux Diagnosed upon

Objective: Vesicoureteral reflux (VUR) constitutes 10- 20% of all antenatal hydronephrosis cases. In this study, 21 cases who have been monitored by reason of primary VUR diagnosis upon antenatal hydronephrosis were evaluated. Treatment and monitoring results are discussed in the light of literature.Material and Methods: 21 (36 renal-ureter units) cases being followed-up with a primary VUR diagnosis after antenatal hydronephrosis symptom between May 2006 and June 2013 in our clinic were evaluated retrospectively. Genders, ages of application, VUR and hydronephrosis grades of the cases were evaluated. Circumcision situation of the male cases and prophylactic antibiotic usage periods were obtained from the hospital file resources and by contacting their parents. The cases were divided into 3 groups as those who had undergone ureteroneocystostomy (UNC) as the first intervention, those who had undergone subureteral material injection (STING) as the first intervention followed by UNC, and those who have just undergone STING and were being followed-up.Results: 21 cases, 3 female (14.3%) and 18 male (85.7%), who were found to have primary VUR after an intrauterine hydronephrosis diagnosis were included in the evaluation. The cases had reflux in 36 renal-ureter units in total including 15 cases (71.4%) that were bilateral, 4 cases (19.1%) in the left and 2 cases (9.5%) in the right ureter. In the whole series, second-degree reflux existed in 1 ureter (2.7%), third-degree reflux in 6 (16.6%) ureters, fourth-degree reflux in 6 (16.6%) ureters and fifth-degree reflux in 23 (63.8%) ureters. STING was applied as the first intervention in 32 ureter units. On the other hand, UNC was applied as the first intervention in 2 (4 ureter units) cases. It was seen that UTI was ongoing after STING intervention in 8 of 19 cases. Simultaneous circumcision operation was performed in any STING session in 14 of the 18 males. It was seen that UTI disappeared in 10 of those circumcised and recurrent UTI was ongoing in 4 of them. It was seen that reflux disappeared only upon STING application in 14 (38.8%) of 36 ureters. It was also seen that 18 (50%) ureters recovered from reflux after the application of UNC. Surgical treatment success rate was 88.8% in the primary VUR cases diagnosed upon antenatal hydronephrosis.Conclusion: High-grade VUR patients diagnosed upon antenatal hydronephrosis and having affected renal functions should be considered as candidates for chronic renal failure by reason of the dysplasia that has developed in the intrauterine period and should be followed-up closely.

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