腎臟移植術後病患膀胱輸尿管逆流之內視鏡治療

丁偉峰、王敘涵、朱聖賢、陳孝文、王大民、江仰仁、劉冠麟、林國仁

林口長庚紀念醫院 外科部 泌尿外科

Endoscopic treatment for post renal transplant vesicoureteral reflux patient

Wei-Feng Ding, Hsu-Han Wang, Sheng-Hsien Chu, Hsiao-Wen Chen, Ta-Min Wang, Yang-Jen Chiang, Kuan-Lin Liu, Kuo-Jen Lin

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou

Purpose: Vesicoureteral reflux(VUR) is a complication after renal transplant. VUR may cause recurrent urinary tract infection , acute pyelonephritis ,even deteriorate renal function in long term effects. Open surgery correction is a standard procedure to treat VUR but minimal invasive endoscopic surgery is an alternative management choice. We are interested in the efficacy of endoscopic treatment for post renal transplant VUR.

Materials and Methods: Total 6 patients received post renal transplant VUR treatment via endoscopy Deflux injection therapy were enrolled during 2014~2017. All patients had stable function graft kidney when they were diagnosed and treated. We analyze the patient age of renal transplant , voiding cystourethrogram (VCUG) VUR grading , pre-op and post-op creatinine level , urinary tract infection related admission times , endoscopic treatment time and Deflux injection amount , urine analysis data . Patient received the surgery under spinal anesthesia and peri-neocystostomy ureteral orifice injection were performed.

Results:

Of all 6 collected patients , 5 patient received the surgery smoothly, one failed case due to invisible neo-orifice of graft kidney ureter. Average admission times were decreased (1.5times/year) compared to pre-op (1.8 times/year) and some patient had zero times of admission after the treatment. One patient had received VCUG follow up and no VUR was noted under follow up. In addition, we found that no significance trend or improving between pre-op and post-op creatinine level. However, urinary analysis data disclosed grossly improved urinary tract infection after the surgical correction.

Conclusions: Despite open surgery is a standard surgery for VUR , it may bring more risk and surgical morbidity to patients who are immune compromised and open wound infection rate may increase due to more invasive procedure. We reviewed our endoscopic treatment result for VUR and disclosed endoscopic surgery will decrease recurrent urinary tract infection and prevent patients from admission. No immediate post operation complication was noted. We convince it will be the promising alternative treatment for post-renal transplant VUR. However, more patients and further follow up VCUG data will be done to confirm the efficacy of endoscopic injection.