OBJECTIVE To establish the efficacy of Macroplastique in treating vesico-ureteric reflux (VUR) in adults with neuropathic bladder dysfunction. PATIENTS AND METHODS Fifteen patients (12 male and three female), age range 19 to 80 years (mean age 38) were included in this study. Diagnosis was confirmed by videourodynamics. In seven patients reflux was present bilaterally. Twenty-two refluxing ureters were treated. Twelve patients had detrusor hyper-reflexia, two had areflexic bladders and one had loss of bladder wall compliance. According to the International Grading System, 10 ureters had grade IV reflux, five had grade III reflux, five had grade II reflux, and two had grade I reflux. Macroplastique (0.5-1.5 ml) was injected submucosally under each ureteric orifice to convert the opening to a slit like shape. The patients were followed up from 9 to 68 months. RESULTS VUR was completely resolved in 72.7% (16) ureters following a single injection and in a further 4.5% (1) ureter following a second injection. 9.1% (2) ureters were improved and treatment failed in 13.7% (3) ureters. Two patients showed a recurrence of reflux 1 and 4 years after primary injection and subsequently had a curative second injection. Most of the patients in whom VUR was cured or improved showed a reduction in laboratory proven urinary infection rates. CONCLUSION Macroplastique produced an excellent result (86% with complete resolution or improvement of reflux) in treating VUR in adult neuropathic bladders. This is comparable to larger studies carried out on the paediatric population. This is an easy procedure, which avoids major surgery and can be performed as a day case. In cases of failure or recurrence, repeat injection or open surgery can be undertaken without any added complications.

中文翻译：

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患有聚二甲基硅氧烷（Macroplastique）治疗的神经性膀胱成人的输尿管输尿管反流。

目的建立Macroplastique治疗成人神经性膀胱功能障碍的膀胱输尿管反流（VUR）的疗效。患者与方法本研究包括15例患者（男12例，女3例），年龄范围19至80岁（平均年龄38）。通过视频尿动力学证实了诊断。7例患者双侧出现反流。治疗了十二个回流输尿管。12例患者出现逼尿肌反射亢进，2例患有曲挠性膀胱，1例患者膀胱壁顺应性下降。根据国际分级系统，有10个输尿管有IV级返流，有5个具有III级返流，有5个具有II级返流，有两个有I级返流。在每个输尿管口下粘膜下注射巨塑（0.5-1.5 ml），以将开口转变成狭缝状。随访9至68个月。结果单次注射后，VUR在72.7％（16）的输尿管中完全溶解，第二次注射后在4.5％（1）的输尿管中完全溶解。9.1％（2）的输尿管得到改善，而13.7％（3）的输尿管治疗失败。初次注射后1年和4年，两名患者表现出反流复发，随后进行了治愈性第二次注射。治愈或改善了VUR的大多数患者在实验室证明的泌尿感染率上都有下降。结论Macroplastique治疗成人神经病性膀胱VUR取得了极好的效果（86％完全解决或反流改善）。这与对儿科人群进行的较大研究相当。这是一个简单的过程，避免了大手术，并且可以按日进行。