방광요관역류 치료를 위한 Dextranomer/Hyaluronic Acid Copolymer 주사 요법에서의 술 후 결과 및 성공 예측 인자
Overall Outcomes and Factors Predicting the Success of Endoscopic Dextranomer/Hyaluronic Acid Copolymer Injection for Vesicoureteral Reflux
강민용, 박용현, 박동수, 최황, 백민기, 이정원,
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강민용 ( Kang Min-Yong )
서울대학교 의과대학 비뇨기과학교실
박용현 ( Park Yong-Hyun )
서울대학교 의과대학 비뇨기과학교실
박동수 ( Park Dong-Soo )
서울대학교 의과대학 비뇨기과학교실
최황 ( Choi Hwang )
서울대학교 의과대학 비뇨기과학교실
백민기 ( Baek Min-Ki )
건국대학교 의학전문대학원 비뇨기과학교실
이정원 ( Lee Jeong-Won )
서울대학교 의과대학 핵의학교실
KMID : 0358320090500010051
Abstract
Purpose: We aimed to evaluate the overall outcomes of endoscopic dextranomer/hyaluronic acid copolymer(Deflux) injection for vesicoureteral reflux(VUR) and analyze the factors predicting success.
Materials and Methods: A total 99 patients(58 males, 41 females) and 154 refluxing ureter units were treated with a endoscopic Deflux injection for VUR. At 3 months, radioisotope-voiding cystograms were performed to evaluate treatment responsiveness; success was defined as a resolving of VUR to less than grade I. We evaluated various perioperative factors such as gender, operation age, preoperative antibiotics duration, urinary tract infection, relative renal function and cortical defect, preoperative VUR grade, maximal flow rate in uroflowmetry, laterality of reflux, voiding dysfunction, constipation, orifice shape and trabeculation, injection technique, injection volume, number of punctures, and learning curve.
Results: The overall success rate was 62.3%(96/154) in refluxing ureter units(50.5% in patients). According to grade of VUR, the success rate was 87.5%(8/9), 82.2%(37/45), 67.8%(38/56), 33.3%(13/39), and 16.7% (1/6) in grade I, II, III, IV, and V, respectively(p=0.001). In multivariate analysis, preoperative VUR grade and mound morphology were identified as predictive factors(p＜0.05). No significant surgery-related complications developed.
Conclusions: Endoscopic Deflux injection for VUR was effective for grade I-III VUR, although the cure rate was low for grade IV-V. The factors predicting success were preoperative VUR grade and mound morphology. (Korean J Urol 2009;50:51-56)
키워드
Vesico-ureteral reflux;Endoscopy;Deflux
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