nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-526Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESУретеронеоцистоанастомоз с отсроченной эндовезикальной антирефлюксной защитой - новый метод профилактики пузырномочеточникового рефлюкса после трансплантации почки: рандомизированное клиническое исследованиеUreteroneocystostomy with delayed endovesical antireflux defense - the new method of prophylaxis of transplant vesicoureteral reflux: randomized clinical studyКалачикО. В.KalachykA. V.oleg_kalachik@hotmail.comНарбинА. В.NarbinA. V.noemail@neicon.ruШкутовА. О.ShkutovA. O.noemail@neicon.ruКозловаМ. В.KozlovaM. V.noemail@neicon.ruУчреждение здравоохранения «9-я городская клиническая больница» г. МинскаРоссия9th city clinical hospitalRussian Federation201529082024174452458Copyright © Калачик О.В., Нарбин А.В., Шкутов А.О., Козлова М.В., 20242024Калачик О.В., Нарбин А.В., Шкутов А.О., Козлова М.В.Kalachyk A.V., Narbin A.V., Shkutov A.O., Kozlova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/526

Цель исследования: одним из недостатков методов формирования уретеронеоцистоанастомоза (УНЦА) является высокая частота пузырно-мочеточникового рефлюкса (ПМР) после трансплантации почки. Это состояние ассоциировано с риском инфекции мочевых путей и дисфункцией пересаженной почки. Целью исследования была разработка нового метода медицинской профилактики ПМР и оценка его клинической эффективности. Методы: проведено ретроспективное исследование для поиска факторов риска ПМР у 68 реципиентов трансплантата почки. На основании их анализа предложен новый метод профилактики ПМР. Для оценки его эффективности проведено рандомизированное проспективное клиническое исследование сравнения с методом Лича-Грегуара у 36 реципиентов почки. Результаты: установлено, что основным фактором риска ПМР почки является остаточный объем мочи на момент операции. Разработан метод УНЦА с отсроченной антирефлюксной защитой путем эндовезикального введения объем-образующей субстанции в зону устья мочеточника трансплантата почки. Доказано, что этот метод позволяет снизить частоту ПМР у пациентов группы риска с 72% до 28% (р=0,0184). Кроме этого, показано, что он ассоциирован со снижением частоты ИМП, длительности операции и обладает достаточной степенью безопасности.

Objective of the study. The high prevalence of vesico-ureteral reflux (VUR) in kidney graft is one of the weaknesses in the kidney transplantation. This condition is associated with the risk of urinary tract infections and renal allograft dysfunction. The objective of this study was the development of new method of VUR medical prophylaxis and evaluation of it clinical efficacy. Methods. We conducted retrospective study to find the risks factors of VUR in kidney transplant. 68 patients were included to the study. Based on the found risks factors, we proposed a new method of medical prophylaxis of VUR. To evaluate its efficacy we run the randomized prospective controlled clinical study to compare with Lich-Gregoir method in 36 patients. Results. We found that the main risk factor of VUR is the low residual volume of urine output. We created the new method of ureteroneocystostomy with delayed antireflux defence by endovesical injection of periureteral bulking substances. We conducted randomized prospective clinical study of the efficacy of new method compared with routine Lich-Gregour technique. We found that it helps to reduce the frequency of VUR in the risk patients from 72% to 28% (p=0.0184). Besides, we found that our method was associated with reduces risks of UTI, shortness of surgery time and provides the reasonable degree of safety.

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The authors declare that there are no conflicts of interest present.