Journal of Reconstructive Urology

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Kadınlarda Primer Vezikoüreteral Reflü Tedavisinde, Karbon Kaplı Boncuklar ve Dekstranomer/Hiyalüronik Asidin Değerlendirilmesi
Carbon Coated Beads and Dextranomer/Hyaluronic Acid Copolymer in the Treatment of Primary Vesicoureteral Reflux of Female Adults
Osman KÖSEa, Bilal GÜNAYDINb, Yiğit AKINa, Sacit Nuri GÖRGELa, Serkan ÖZCANa, Enis Mert YORULMAZa, Kenan ÖZTORUNb, Yüksel YILMAZa
aİzmir Kâtip Çelebi Üniversitesi Tıp Fakültesi, Üroloji ABD, İzmir, TÜRKİYE
b Niğde Ömer Halisdemir Üniversitesi Tıp Fakültesi, Üroloji ABD, Niğde, TÜRKİYE
J Reconstr Urol. 2020;10(2):49-55
doi: 10.5336/urology.2020-75589
Article Language: TR
Full Text
ÖZET
 Amaç: Karbon kaplı boncuklar (Durasphere®) ve dekstranomer/hiyalüronik asit kopolimeri (Deflux®) ile primer grade I-III primer vezikoüreteral reflü (VUR) nedeni ile endoskopik subüreterik enjeksiyon yapılan erişkin kadın hastaları retrospektif olarak değerlendirdik. Gereç ve Yöntemler: İzmir Kâtip Çelebi Üniversitesi Tıp Fakültesi ve Niğde Ömer Halisdemir Üniversitesi Tıp Fakültesinin üroloji bölümlerinde, primer grade I-III VUR nedeni ile endoskopik subüreteral enjeksiyon yapılan kadınların tıbbi kayıtları retrospektif olarak gözden geçirildi. Nörojenik mesaneye sekonder VUR, infravezikal obstrüksiyon, mesane tümörünün rezeksiyonu, üreterosel insizyonu veya üreteral reimplantasyonu olan ve 18 yaşın altındaki hastalar çalışma dışı bırakıldı. Bulgular: Durasphere® grubu; preoperatif grade II ve III VUR sırasıyla 7 ve 8 üreterde tespit edildi. Üç hastada bilateral VUR vardı. Cinsel olarak aktif 10 ve tekrarlayan üriner enfeksiyonu olan 7 hasta mevcuttu. Doğum yapan 7 hastanın 6'sında, gebelik sırasında hastaneye yatırılması gereken piyelonefrit öyküsü vardı. Ortalama 38,00±14,70 aylık takip periyodunda vezikoüreteral obstrüksiyon gözlenmedi, ancak 2 olguda VUR nüksüne bağlı ikinci endoskopik girişim, 1 hastaya Cohen üreteroneosistostomi yapıldı. Deflux® grubu; On dört hastanın 3'ünde bilateral VUR vardı. Grade I, II ve III reflü, sırasıyla 3, 8 ve 6 böbrek ünitesinde izlendi. Hastaların 13'ü cinsel olarak aktif olup, 11'inde doğum öyküsü, 6'sında tekrarlayan idrar yolu enfeksiyonu, 4'ünde gebelik sırasında piyelonefrit nedeni ile hastanede yatış öyküsü vardı. Dört hastaya, başarısızlık nedeni ile ikinci endoskopik subüreterik enjeksiyon uygulandı. Gruplarda postoperatif piyelonefrit izlenmedi. Sonuç: Karbon kaplı boncuklar güvenli, uygulanabilir, etkili subüreterik hacim artırıcı maddedir ve erişkin kadın popülasyonunda ciddi dilatasyon olmayan reflüksif üreterlerinin endoskopik tedavisinde Deflux® ile karşılaştırılabilir sonuçlara sahiptir.

Anahtar Kelimeler: Deflux®; Durasphere®; kadın; vezikoüreteral reflü
ABSTRACT
 Objective: We retrospectively evaluated adult female patients who received endoscopic subureteric injection due to carboncoated beads (Durasphere®) and dextranomer/hyaluronic acid copolymer (Deflux®) with primary grade I-III primary vesicoureteral reflux (VUR). Material and Methods: Medical records of women who underwent endoscopic suburethral injection due to primary grade I-III VUR in the urology departments of İzmir Kâtip Çelebi University Faculty of Medicine and Niğde Ömer Halisdemir University Faculty of Medicine were retrospectively reviewed. Patients with secondary VUR to neurogenic bladder, infravesical obstruction, bladder tumor resection, ureterocele incision or ureteral reimplantation, and being under 18 years of age were excluded from the study. Results: Durasphere® group; preoperative grade-II and III VUR were detected in 7 and 8 ureters, respectively. Three patients had bilateral VUR. There were 10 sexually active and 7 patients with recurrent urinary infections. Six of 7 delivered patients had a history of hospitalization during pregnancy due to pyelonephritis. In 38,00±14,70 months follow-up period, there was no vesicoureteral obstruction, but 2 cases needed second endoscopic intervention for VUR recurrence, 1 underwent Cohen ureteroneocystostomy. Deflux® group; three of 14 patients had bilateral VUR. Grade I, II and III reflux was observed in 3, 8 and 6 units, respectively. Thirteen patients were sexually active, 11 were delivered, 6 had recurrent urinary tract infections, and 4 had history of hospitalization for pyelonephritis during pregnancy. Four patients underwent second endoscopic subureteric injection for failure. Postoperative pyelonephritis was not observed in the groups. Conclusion: Carbon coated beads are safe, feasible, effective subureteric bulking agent and have comparable results with Deflux® in the endoscopic treatment of reflux ureters without serious dilatation in the adult female population.

Keywords: Deflux®; Durasphere®; female; vesicoureteral reflux
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