European urology · 1999
Possible causes of unsuccessful endoscopic collagen treatment of vesicoureteric reflux in children.
СтатьяНазвание и аннотация: Перевод в очереди
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van der Hoek W, Schneeberger P M, Oomen T, Wegdam-Blans M C, Dijkstra F, Notermans D W, Bijlmer H A, Groeneveld K, Wijkmans C J, Rietveld A, Kampschreur L M, van Duynhoven Y
Аннотация
OBJECTIVE: The purpose of this prospective study was to identify possible causes of unsuccessful treatment of vesicoureteric reflux (VUR) in children by endoscopic collagen injection.
PATIENTS AND METHODS: Between February 1994 and September 1996, 130 primary VURs in 94 children aged 3-16 years were treated by endoscopic injection of collagen. Grade 2 VUR was found in 46 ureteric units, grade 3 in 55, and grade 4 in 11 ureteric units. Seventy-seven children had normal micturition, and 17 showed signs of an unstable bladder. The collagen injection was performed under general anaesthesia. All children had a follow-up assessment on average 5.1 months after the first injection of collagen. They were evaluated by micturition cystography and ultrasound examination of the urinary tract.
RESULTS: A single injection of collagen eliminated VUR in 74 (56.9%) cases. There was a statistically significant correlation between the grade of VUR and the success rate of collagen therapy (p < 0.01). The average amount of collagen used in cured and in noncured children was 0.55 and 0.76 ml, respectively (p < 0.01). Children with normal appearance of the ureteric orifice had significantly better results as compared with other children (p < 0.01). There was no statistically significant correlation between the success rate of treatment and the place of collagen injection or the shape of ureteric orifice following the injection. A statistically significant association, however, was found between the function of the lower urinary tract and the results of endoscopic collagen treatment for VUR (p < 0.05). Ultrasound showed no obstruction of the upper urinary tract.
CONCLUSION: High-grade VUR, incorrect technique of injection, and voiding dysfunction seem to be some of the possible causes of an unsuccessful endoscopic collagen treatment of VUR in children.
PATIENTS AND METHODS: Between February 1994 and September 1996, 130 primary VURs in 94 children aged 3-16 years were treated by endoscopic injection of collagen. Grade 2 VUR was found in 46 ureteric units, grade 3 in 55, and grade 4 in 11 ureteric units. Seventy-seven children had normal micturition, and 17 showed signs of an unstable bladder. The collagen injection was performed under general anaesthesia. All children had a follow-up assessment on average 5.1 months after the first injection of collagen. They were evaluated by micturition cystography and ultrasound examination of the urinary tract.
RESULTS: A single injection of collagen eliminated VUR in 74 (56.9%) cases. There was a statistically significant correlation between the grade of VUR and the success rate of collagen therapy (p < 0.01). The average amount of collagen used in cured and in noncured children was 0.55 and 0.76 ml, respectively (p < 0.01). Children with normal appearance of the ureteric orifice had significantly better results as compared with other children (p < 0.01). There was no statistically significant correlation between the success rate of treatment and the place of collagen injection or the shape of ureteric orifice following the injection. A statistically significant association, however, was found between the function of the lower urinary tract and the results of endoscopic collagen treatment for VUR (p < 0.05). Ultrasound showed no obstruction of the upper urinary tract.
CONCLUSION: High-grade VUR, incorrect technique of injection, and voiding dysfunction seem to be some of the possible causes of an unsuccessful endoscopic collagen treatment of VUR in children.