膀胱三角下層注射術Deflux®治療兒童膀胱輸尿管逆流之成效探討
林琨哲, 鄭鴻琳
國立成功大學附設醫院泌尿部
Subureteric transurethral injection(Sting) in children with Deflux® injection- NCKUH experience
Kun-Che Lin, Hong-Lin Cheng.
Department of Urology, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan
Purpose: Vesicoureteral reflux (VUR) is a common and treatment worthy disease in children. A proper treatment in children with VUR may guarantee preservation of normal renal function, prevent pyelonephritis and renal failure in the future of his/her life. Minimal invasive endoscopic injection of bulking agents has gradually gained popularity as a treatment alternative in VUR. We present a single center experience of endoscopic Deflux® injection for treating VUR in recent 10 years.
Materials and Methods: The patients conducted endoscopic Deflux® injection from 2007 to 2017, were enrolled. All the children were referred for VUR treatment with repeat febrile urinary tract infection (FUTI). Initial evaluations included renal ultrasound, voiding cystourethrography (VCUG) and DMSA scan with SPECT. The grading of VUR severity was clarified according to VCUG. Direct radionuclide cystography (RNC) was examined 3 months later in follow-up. Surgical indications included repeated FUTIs with VUR. All the enrolled patients underwent endoscopic Deflux injection as the first operation treatment.
Results: Deflux® injection was performed in 21 patients, 12 males and 9 females, with a total of 27 renal units. The median age was 30.3 months (6 month-96 month). Follow-up period was 26.3 months. The pre-intervention VUR grading were grade I: 3 renal units, II: 2, III: 13, IV: 8, V:1. Of the 7 patients with bilateral VUR, 6 received Deflux® injection in both side. Primary reflux resolution was 77.7% (21/27). The secondary Deflux® injection reflux resolution was 100% (1/1). In follow up, 7 patients (33.3%) had febrile UTI, and 1 patient (4.5%) had hematuria.
Summary: Endoscopic intervention via STING injection of Deflux® is a minimal invasive, quick recovery and safe technique as a treatment alternative for children with VUR.