Endoscopic Treatment of Symptomatic Vesicoureteral Reflux after Renal Transplantation

被引:30
作者
Akiki, Akram [1 ]
Boissier, Romain [1 ]
Delaporte, Veronique [1 ]
Maurin, Charlotte [1 ]
Gaillet, Sarah [1 ]
Karsenty, Gilles [1 ]
Coulange, Christian [1 ]
Lechevallier, Eric [1 ]
机构
[1] La Concept Univ Hosp, Dept Urol & Kidney Transplantat, Marseille, France
关键词
kidney transplantation; vesico-ureteral reflux; baysilon; dextranomer-hyaluronic acid copolymer; endoscopy; DEXTRANOMER/HYALURONIC ACID COPOLYMER; KIDNEY-TRANSPLANTATION; UROLOGIC COMPLICATIONS; CLINICAL-SIGNIFICANCE; LONG-TERM; PYELONEPHRITIS; INJECTIONS; CHILDREN; THERAPY; SYSTEM;
D O I
10.1016/j.juro.2014.07.103
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We evaluated the success of endoscopic treatment of symptomatic vesicoureteral reflux after renal transplantation and identified factors predicting success. Materials and Methods: Endoscopy was performed for symptomatic vesicoureteral reflux after renal transplantation in 38 women and 20 men between January 2000 and December 2010. Reflux was documented by retrograde cystography and its symptomatic character was determined by at least 1 episode of acute graft pyelonephritis. The results of endoscopic treatment were evaluated clinically at 1 and 3 months, and annually, and by cystography at 3 months. Clinical success was defined as absent acute graft pyelonephritis during followup. Radiological success was defined as absent reflux on followup cystography at 3 months. Results: Endoscopic treatment was clinically successful in 32 patients (56.1%), including 26 (65%) who received dextranomer-hyaluronic acid and 5 (33.3%) who received polydimethylsiloxane. Treatment was radiologically successful in 14 patients (26.4%) at a mean +/- SD followup of 38 +/- 33 months. On multivariate analysis male gender and dextranomer-hyaluronic acid were factors predictive of clinical success. Reflux grade did not predict success or failure. No high grade complication was reported. Conclusions: Endoscopic treatment of symptomatic vesicoureteral reflux of a transplanted kidney was effective in half of the cases regardless of the bulking agent used. However, dextranomer-hyaluronic acid appeared to be more effective than polydimethylsiloxane. Due to its minimally invasive nature and low morbidity endoscopic treatment with dextranomer-hyaluronic acid could be proposed as preoperative first line treatment for symptomatic vesicoureteral reflux of a transplanted kidney regardless of reflux grade.
引用
收藏
页码:225 / 229
页数:5
相关论文
共 30 条
[1]   Vesicoureteral reflux: surgical approaches [J].
Austin, JC ;
Cooper, CS .
UROLOGIC CLINICS OF NORTH AMERICA, 2004, 31 (03) :543-+
[2]   ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX IN TRANSPLANTED KIDNEYS [J].
CLOIX, P ;
GELET, A ;
DESMETTRE, O ;
COCHAT, P ;
GARNIER, JL ;
DUBERNARD, JM ;
MARTIN, X .
BRITISH JOURNAL OF UROLOGY, 1993, 72 (01) :20-22
[3]   Vesicoureteric reflux is not a benign condition [J].
Coulthard, Malcolm G. .
PEDIATRIC NEPHROLOGY, 2009, 24 (02) :227-232
[4]   Endoscopic therapy for vesicoureteral reflux: A meta-analysis. I. Reflux resolution and urinary tract infection [J].
Elder, JS ;
Diaz, M ;
Caldamone, AA ;
Cendron, M ;
Greenfield, S ;
Hurwitz, R ;
Kirsch, A ;
Koyle, MA ;
Pope, J ;
Shapiro, E .
JOURNAL OF UROLOGY, 2006, 175 (02) :716-722
[5]  
European Association of Urology, 2012, GUID 2012
[6]   Gender has no influence on VUR rates after renal transplantation [J].
Farr, Alex ;
Gyoeri, Georg ;
Muehlbacher, Ferdinand ;
Husslein, Peter ;
Boehmig, Georg A. ;
Margreiter, Markus .
TRANSPLANT INTERNATIONAL, 2014, 27 (11) :1152-1158
[7]   Management of Urologic Complications in Renal Transplantation: A Single-Center Experience [J].
Hau, H. M. ;
Tautenhahn, H. -M. ;
Schmelzle, M. ;
Krenzien, F. ;
Schoenberg, M. B. ;
Morgul, M. H. ;
Uhlmann, D. ;
Wiltberger, G. ;
Rasche, M. ;
Bachmann, A. ;
Jonas, S. ;
Bartels, M. .
TRANSPLANTATION PROCEEDINGS, 2014, 46 (05) :1332-1339
[8]  
Joshi PN JA, 2004, Transplantation, V78, P250, DOI DOI 10.1097/00007890-200407271-00661
[9]   Surgical complications in kidney transplantation [J].
Karam, G. ;
Maillet, F. ;
Braud, G. ;
Battisti, S. ;
Hetet, J. -F. ;
Glemain, P. ;
Le Normand, L. ;
Bouchot, O. ;
Rigaud, J. .
ANNALES D UROLOGIE, 2007, 41 (06) :261-275
[10]   The modified sting procedure to correct vesicoureteral reflux: Improved results with submucosal implantation within the intramural ureter [J].
Kirsch, AJ ;
Perez-Brayfield, M ;
Smith, EA ;
Scherz, HC .
JOURNAL OF UROLOGY, 2004, 171 (06) :2413-2416