Hutch diverticulum: A risk factor of recurrent vesicoureteral reflux in renal transplant group after minimally invasive endoscopic surgery

Hutch憩室: 腎臟移植族群發生膀胱輸尿管逆流，經內視鏡治療後復發的一項危險因子

研究目的（Purpose）:

Vesicoureteral reflux (VUR) is a widely known complication after kidney transplant and it may cause recurrent urinary tract infection (UTI), acute pyelonephritis, even deteriorate renal function in long-term effects. Nowadays, minimally invasive endoscopic surgery is the first choice of treatment with reported recurrence rate of 31-90%. We are interested in recurrent VUR after endoscopic treatment for post kidney transplant VUR.

材料與方法（Materials and Methods）:

From 2014 to 2023, a total 20 patients received endoscopic Deflux™ injection therapy for their symptomatic de novo VUR after kidney transplant. All patients had a functioning graft kidney at the time of diagnosis. We analyzed the patient’s age at the time of kidney transplant, VUR grading, pre- and post-injection serum creatinine levels, VCUG parameters, Body Mass Index, UTI-associated admissions, the amount of Deflux injection, and urine analysis data.

結果（Results）:

Of all 20 collected patients, five patients had recurrence of their VUR at a mean time of 2 months after injection. The ureter length was significantly longer in success group (9.8 cm vs 6.64 cm P = 0.007). We reviewed voiding cystoureterography (VCUG) image of all the 20 patients and noticed that 4 patients in failure group (total 5 patients) had a volcano shape bulge over ureteral-vesical junction, which was not seen in the success group. We called the volcano shape bulge as Hutch diverticulum created iatrogenically.

結論（Conclusions）:

Endoscopic Deflux injection is a safe and minimally invasive treatment for post kidney transplant VUR. If Hutch diverticulum present, minimally invasive endoscopic surgery may not be indicated due to the gel can’t be injected to the appropriate sub-mucosa layer. Repeat Deflux treatment might be wasted and delay the accurate management. However, we still need further study for our hypothesis.

作者:

Yu-Chieh Yen¹、Pai-Yen Pan¹、Chung-Lin Lee¹、Ta-Min Wang^1；2、Sy-Yuan Chen¹、Chit-Te Lin^1；2、Sheng-Hsien Chu^1；2、Kuo-Jen Lin^1；2、Hsu-Han Wang^1；2

1Division of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan;

2College of Medicine, Chang Gung University, Taoyuan, Taiwan.

顏佑潔、潘柏諺、李宗霖、王大民、陳思遠、林志德、朱聖賢、林國仁、王敘涵

林口長庚醫院泌尿科

長庚大學