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Therapieoptionen beim primären vesikoureteralen Reflux

Endoskopie vs. offen-chirurgische Verfahren

Therapeutic options for primary vesicoureteral reflux

Endoscopic vs open surgical approach

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Zusammenfassung

Die Therapie des vesikoureteralen Refluxes (VUR) hat sich in den letzten 10 Jahren stetig gewandelt. Offen-chirurgische Operationsverfahren wie z. B. die extravesikale Methode nach Lich-Gregoir oder die Ureterozystoneostomie im Psoas-Hitch-Verfahren, Referenzstandards mit sehr guten Erfolgsergebnissen, werden seltener angewandt. Die endoskopische Unterspritzung mit Dextranomer-Mikrosphären/Hyaluronsäure (Deflux®) hat sich seit ihrer Zulassung durch die US-amerikanische „Food and Drug Administration“ (FDA) 2001 zunehmend verbreitet. Kontrovers wird nach wie vor die Anwendung der sog. „bulking agents“ wie z. B. Deflux® beim dilatierenden und höhergradigen VUR diskutiert, während sie zunehmend beim niedriggradigen Reflux akzeptiert wird. Trotz höherer Rezidivraten bei allen VUR-Graden wird die „minimal-invasive Unterspritzung“ zunehmend häufiger angewendet. Letztlich muss die Frage beantwortet werden, von welcher Therapie (sofern nötig) der Patient am meisten profitiert. Welchen Stellenwert hat die endoskopische subureterale Unterspritzung erlangt und sind offene Operationen zur Therapie des VUR „out“?

Abstract

Therapy of vesicoureteral reflux (VUR) has steadily changed during the last decade. Open surgical procedures, e.g. extravesical reflux repair with the Lich-Gregoir technique or ureterocystoneostomy with the psoas hitch technique, reference standards with excellent success rates, are less frequently used. Since its approval by the US Food and Drug Administration (FDA) endoscopic reflux therapy with Deflux® has gained more and more popularity. However, the usage of so-called bulking agents, e.g. Deflux®, still remains controversial in dilating reflux, while its application for low-grade VUR is increasingly being accepted. Despite higher recurrence rates in all grades of VUR, the use of the “minimally invasive injection” is increasing. The question has to be answered which therapy – if necessary – benefits the patient most. Which role has the subureteral injection gained and are open surgical procedures for VUR therapy “out”?

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  1. Abteilung für Kinderurologie, Urologische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    C. Ziesel, S. Frees, J.W. Thüroff & R. Stein

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  1. C. Ziesel
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  4. R. Stein
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Ziesel, C., Frees, S., Thüroff, J. et al. Therapieoptionen beim primären vesikoureteralen Reflux. Urologe 51, 352–356 (2012). https://doi.org/10.1007/s00120-012-2805-x

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