Efficiency of endoscopic treatment compared to open surgical management of the vesicoureteral reflux - Mugabe, Herbert; Kojović, Vladimir (Medicinski podmladak, 2018)
EFFICIENCY OF ENDOSCOPIC TREATMENT COMPARED TO OPEN SURGICAL MANAGEMENT OF THE VESICOURETERAL REFLUX University of Belgrade, School of Medicine Institute for Mother and Child Health Care of Serbia ˝Dr Vukan Čupić˝, Belgrade ABSTRACT Introduction: Vesicoureteral reflux (VUR) represents the retrograde flow of urine from the bladder to the upper urinary tract. It can be managed by continuous antibiotic prophylaxis of the urinary tract infections until spontaneous resolution occurs, surgical ureteral reimplantation (ureteroneocystostomy), or endoscopic treatment by injecting bulking agents. The aim: To assess the efficacy of the endoscopic treatment of VUR in comparison to the ureteroneocystostomy. Material and methods: The first group included 300 children with VUR, II to IV grades managed by endoscopic injection from 2005 to 2015, and second group included 300 patients who underwent surgical treatment for the IV or V grade of VUR from 1997 until 2009. The results of treatment and complication rate were analysed and compared. We did the same analyses considering the total number of ureteral units. Results: Of total of 300 patients treated endoscopically, in 281 (93.67%) patients the reflux was completely resolved; in 10 (3.33%), the reflux was downgraded (decreased for one or two grades) and in 9 (3%) the intervention was unsuccessful. In 430 ureteral units, full resolution was achieved in 402 (93.49%) units; in 10 (2.33%), the reflux was downgraded and in 18 (4.65%) the reflux didn’t resolve. In 300 patients who underwent open surgery, in 290 (96.7%) the reflux was resolved; in 8 (2.67%), the reflux was downgraded from the V/IV to the grades I to III; in 2 (0.66%) the operation was unsuccessful. Out of 480 ureteral units, in 463 (96.46%) units the reflux was resolved; in 13 (2.71%), the grade of reflux was reduced, while in 4 (0.83%) units the reflux was persistent. Recorded success rate didn’t show any statistically significant difference between these two groups. The length of hospital stay was significantly shorter and the number of complications was fewer in the group of patients treated by endoscopic injection. Conclusion: Comparable success rate, shorter hospital stay, and fewer complications make the endoscopic treatment more preferable option. Key words: Vesicoureteral reflux, Endoscopic treatment, Ureteral reimplantation EFIKASNOST ENDOSKOPSKE METODE LEČENJA U ODNOSU NA OTVORENU HIRURŠKU KOREKCIJU VEZIKOURETERALNOG REFLUKSA SAŽETAK Uvod: Vezikureteralni refluks (VUR) predstavlja retrogradni tok urina iz bešike do gornjih delova urinarnog trakta. Može se lečiti kontinuiranom antibiotskom profilaksom urinarnih infekcija do spontane rezolucije, otvorenom hirurškom reimplantacijom uretera ili endoskopskim tretmanom pomoću injekcije endopaste. Cilj: Studije efikasnosti endoskopske metode lečenja VURa u odnosu na otvorenu hiruršku korekciju VUR-a. Materijal i metode: Prvu grupu pacijenata čini 300 pacijenata tretiranih endoskopskom injekcijom zbog VUR-a II do IV gradusa od 2005. do 2015.god. Drugu grupu pacijenata sačinjava 300 pacijenata lečenih od 1997. do 2009. god. otvorenom hirurškom reimplanacijom uretera zbog VUR-a IV i V stepena. Rezultati lečenja i učestalost komplikacija kod ove dve grupe pacijenata su analizirani i upoređeni. Takođe, urađena je i analiza u odnosu na ukupan broj ureteralnih jedinica. Rezultati: Od ukupno 300 pacijenata koji su tretirani endoskopski, kod 281 (93,67%) pacijenta refluks je kompletno saniran; kod 10 (3,33%) pacijenata smanjen je stepen refluksa (za jedan ili dva stepena) i kod 9 (3%) pacijenata intervencija je bila potpuno neuspešna. Od 430 ureteralnih jedinica, uspešan tretman refluksa je postignut kod 402 (93,49%) uretera; kod 10 (2,33%) stepen refluksa bio je snižen i kod 18 (4,65%) refluks je i dalje bio prisutan. Od 300 pacijenata podvrgnutih otvorenoj hirurgiji, kod 290 (96,67%) refluks V/IV gradusa je kompletno izlečen; kod 8 (2,67%) slučajeva snižen je stepen sa V/IV na I, II ili III stepen refluksa i kod 2 (0,66%) pacijenta operacija je bila neuspešna. Od 480 ureteralnih jedinica, kod 463 (96,46%) jedinica refluks je izlečen, kod 13 (2,71%), operacija je smanjila stepen VUR-a, dok je kod 4 (0,83%) uretera refluks ostao perzistentan. Rezultati nisu pokazali statistički značajnu razliku između ove dve grupe pacijenata u stepenu uspešnosti lečenja refluksa. Dužina boravka u bolnici je kraća, a učestalost komplikacija manja kod pacijenata lečenih endoskopskom intervencijom. Zaključak: Podjednaka uspešnost lečenja, kraći boravak u bolnici i manje komplikacija dovelo je do toga da endoskopski tretman postane metod izbora u lečenju VUR-a u odnosu na klasični hirurški tretman. Ključne reči: vezikoureteralni refluks, endoskopski tretman, reimplantacija uretera