내시경적 요관점막하 Polydimethylsiloxane 주입법에 의한 소아 방광요관역류 교정의 성적

Abstract

Purpose: We evaluated the efficacy of an endoscopic subureteral injection of polydimethylsiloxane(Macroplastique) for the correction of vesicoureteral reflux in children. Materials and Methods: The medical records of 15 children(19 refluxing ureters), who had undergone a single endoscopic subureteral injection of polydimethylsiloxane for the treatment of vesicoureteral reflux, were reviewed. After the injection, voiding cystourethrograms were performed after 3 to 10 months to evaluate the results. Renal and bladder ultrasonograms were taken after 3 to 30 months to check for the development of de novo hydroureteronephrosis and the presence of the implant at the bladder base. The follow-up duration was between 7 and 43 months. Results: Of the 15 patients, there were 6 boys and 9 girls, with ages ranging from 12 months to 14 years. The reflux was resolved in 10 of the 19 ureters, in 8 of the 15 children, after a single injection. The resolutions of reflux, by grade, were none in 2, 2 in 4, 5 in 7, 1 in 4 and 2 in 2 of the ureters of grade I to V, respectively. The unilateral reflux was resolved in 7 of the 12, the bilateral reflux in 2(3 ureters) of the 3 and the reflux in a duplicated system in 1 of the 3 cases(2 ureters out of 4 ureters). In two cases with persistent reflux, ureteral reimplantations were performed due to repeated urinary tract infections and de novo upper pole ureteral refluxes. The remaining 5 cases with persistent reflux were observed with prophylactic antibiotics. Refluxes recurred in 2 of the ureters at 29 and 36 months after the injection, so chemoprophylaxis was restarted. Conclusions: The single endoscopic subureteral polydimethylsiloxane injections resulted in a low success rate, but at a high cost. This procedure is considered inappropriate as a first line method for the correction of vesicoureteral reflux in children.(Korean J Urol 2003;44:150-154) Key word : Endoscopy,Vesico-ureteral reflux,Polydimethylsiloxane,Injections