排泄性尿路超声造影用于输尿管膀胱再植术治疗儿童膀胱输尿管反流

目的 评价排泄性尿路超声造影（CeVUS）用于输尿管膀胱再植术治疗儿童膀胱输尿管反流（VUR）的价值。方法 纳入16例接受气膀胱腹腔镜输尿管膀胱再植术治疗VUR的患儿,于术前和术后6、12及18个月采用CeVUS评估反流程度,并与排泄性膀胱尿路造影（VCUG）诊断结果对比,采用Kappa检验评价二者诊断分级及评价疗效的一致性。结果 术前和术后6、12及18个月CeVUS分级诊断VUR的敏感度、特异度、准确率、阳性预测值及阴性预测值均较高;与VCUG分级诊断及评价疗效的一致性均极高（P均>0.05）。结论 CeVUS可用诊断儿童VUR,特别适用于术后需多次复查的患儿。     

排泄性尿路超声造影评估儿童膀胱输尿管反流及肾内反流

目的 探讨排泄性尿路超声造影(CeVUS)在诊断儿童膀胱输尿管反流(VUR)及肾内反流(IRR)中的价值，评估IRR与年龄、性别和VUR分级之间的关系。方法 回顾性收集怀疑VUR行CeVUS检查的患儿。所有患儿均行CeVUS检查，分析造影图像，记录反流级别、有无IRR、年龄和性别等资料。结果 在319例患儿中CeVUS检出VUR 138例，其中IRR有59例(42.8%)。IRR患儿年龄中位数为7(2～84)个月，而无IRR年龄中位数为16(1～108)个月(P<0.05)。共有VUR肾输尿管单位202个，其中IRR 77个，IRR在各级别VUR的检出率分别为Ⅱ级5.0%(2/40)、Ⅲ级34.7%(26/75)、Ⅳ级66.2%(43/65)、Ⅴ级40.0%(6/15)。结论 CeVUS可用于儿童VUR及IRR的诊断，IRR多见于Ⅳ级VUR和1岁以内的患儿。     

1例反流性肾病患儿行血液透析治疗的护理

正反流性肾病(reflux nephropathy,RN),最早于1973年由Bailey提出~([1]),是指膀胱输尿管反流(vesicoureteral reflux,VUR)、肾内反流(intrarenal reflux,IRR)引起肾脏瘢痕形成,造成高血压、蛋白尿甚至最终发展为终末期肾衰竭的一类疾病~([2])。有调查显示,VUR在儿童中的发病率为1%~2%,而在儿童的尿路感染中原发性VUR的高达0%~0%,由于反流     

降钙素原对儿童膀胱输尿管反流的预测价值

目的初步探讨降钙素原对儿童尿路感染伴膀胱输尿管反流(VUR)的诊断价值及其与反流严重程度的关系。方法收集2011年1月至2012年3月该院所有连续就诊并诊断为首次发生尿路感染的患儿的降钙素原(PCT)、C反应蛋白(CRP)、尿液细菌培养、泌尿系统B超、排尿期膀胱尿道造影(VUCG)等结果。以VUCG作为VUR与非VUR的分组标准及VUR分级标准。结果共146例尿路感染患儿纳入研究,其中VUR患儿51例(占34.9%),VUR患病年龄、性别比例差异无统计学意义(P>0.05)。VUR组的PCT、CRP水平高于非VUR组(P<0.05),ROC曲线显示PCT诊断性能优于CRP。高PCT水平(≥0.5ng/mL)与VUR的级别密切相关(优势比为5.5,95%置信区间2.3～12.9),且与轻度、中度VUR均密切相关(优势比分别为4.6、9.1,95%置信区间分别为1.8～11.7、1.4～61.7)。结论 PCT对于判断是否存在膀胱输尿管反流具有一定的临床价值,可作为预测反流级别的独立指标,可能有助于减少不必要的VUCG。     

膀胱输尿管反流患儿的临床分析和随访

膀胱输尿管反流（VUR）是一种常见的尿路畸形,严重者可致肾脏损害。重度反流以手术纠正为主,轻、中度反流以低剂量抗生素预防尿路感染为主。本研究对膀胱输尿管反流患儿进行临床分析和随访,现报告如下。1资料与方法选取2009年1月—2011年12月本院尿路感染控制后行X线排尿期膀胱尿路造影（MCU）诊断为VUR的患儿42例,其中首次发生尿路感染者19例,反复尿路感染者37例。     

超声检查在儿童膀胱输尿管反流诊断中的价值

目的 探讨超声在儿童膀胱输尿管反流(vesieoureteral reflux,VUR)诊断中的价值.方法 超声观察33例泌尿系感染患儿肾脏的大小形态、肾窦回声、肾盂肾盏是否扩张、壁是否增厚,并与排尿性膀胱尿路造影的结果对照.结果 以肾窦回声增强,肾盂和/或肾盏扩张、肾盂壁增厚的各种组合为阳性指标,超声提示VUR的敏感度53%～63%,特异性度97%～100%.结论 肾窦回声增强、肾盂和/或肾盏扩张、肾盂壁增厚的各种超声征象组合,均可强烈提示VUR.超声检查阴性不能排除VUR.     

排尿性膀胱尿道造影筛查儿童原发性膀胱输尿管反流的意义

目的探讨排尿性膀胱尿道造影(micturating cystourethrography,MCU)筛查儿童原发性膀胱输尿管反流(vesi-coureteric reflux,VUR)的意义。方法选择40例经99Tcm-二巯基丁二酸(DMSA)显像后肾脏放射性摄取缺损或减少的尿路感染(urinary tract infection,UTI)患儿行MCU检查,依据国际反流性肾病协会提出的VUR分级标准评价MCU诊断结果。结果 40例MCU检查诊断原发性VUR 16例,检出率为40.0%,其中双侧9例,单侧7例;男8例,女8例;年龄<1岁13例。MCU检查共检出VUR 25个肾输尿管单位,其中Ⅱ级反流2支(8.0%),Ⅲ级反流5支(20.0%),Ⅳ级反流12支(48.0%),Ⅴ级反流6支(24.0%)。结论对UTI患儿进行规范的MCU检查可为原发性VUR诊断和治疗提供客观依据。     

几种膀胱输尿管返流诊断方法的评价

本文在56例成年反复尿感病人进行了排尿期膀胱尿路造影(MCU)及同位索间接法膀胱输尿管造影(IVRC)检测膀胱输尿管返流(VUR)的比较,结果发现两者符合率为71.4％,而在RN病人中IVRC及MCU显示返流阳性率分别为59.4％及40.6(P<0.05)。在17只实验性VUR小猪共98侧输尿管进行了MCU及同位素直接法胱输尿管造影(DRC)检测VUR的研究。结果显示两者诊断VUR的总符合率为91.8％。DRC诊断VUR的特异性为92.3％。以上结果提示:IVRC是一种简单、易行、安全的VUR筛选方法;DRC作确诊VUR的新方法,有较大实用价值。     

儿童腹腔镜气膀胱输尿管再吻合手术配合

目的探讨膀胱输尿管返流儿童应用腹腔镜进行膀胱三角区输尿管再植入手术配合。方法对19例患原发性膀胱输尿管返流(VUR)的儿童行气膀胱输尿管再植入手术的配合进行回顾性分析。结果本组病例术后具有创伤小,恢复快,外形美观,无严重并发症的特点。结论高质量的手术配合,有利用儿童输尿管再吻合术的顺利完成。     

儿童腹腔镜气膀胱输尿管再吻合手术配合

目的 探讨膀胱输尿管返流儿童应用腹腔镜进行膀胱三角区输尿管再植入手术配合.方法 对19例患原发性膀胱输尿管返流(VUR)的儿童行气膀胱输尿管再植入手术的配合进行回顾性分析.结果 本组病例术后具有创伤小,恢复快,外形美观,无严重并发症的特点.结论 高质量的手术配合,有利用儿童输尿管再吻合术的顺利完成.     

Possible use of ultrasound estimated bladder weight in evaluating vesicoureteral reflux in children.

The present study was designed to reveal the possible use of ultrasound estimated bladder weight (UEBW) in evaluating vesicoureteral reflux (VUR) in children in terms of possible implication of bladder hypertrophy in VUR. In 27 children with VUR, UEBW was measured by transabdominal ultrasound. The UEBW in an individual patient was evaluated quantitatively using the percent deviation from age matched UEBW. There was a significant difference noted in the percent deviation from age-matched UEBW between patients (n = 17) with primary VUR and those (n = 10) with secondary VUR (p <.05). When analyzed together in 27 patients, a significant positive correlation (p <.05) was recognized between the percent deviation from age-matched UEBW and VUR grade. This was also the case in ten patients with secondary VUR (p <.01), but not for 17 patients with primary VUR. The measurement of UEBW might be of clinical use in evaluating the pathogenesis as well as the severity of VUR in children.     

Kidney length and scarring in children with urinary tract infection: importance of ultrasound scans

Background Many studies have demonstrated that dimercaptosuccinic acid (DMSA) scintigraphy is the most sensitive diagnostic method in the identification of irreversible renal lesions (scars) in children with previous episodes of acute pyelonephritis (APN). This study assessed the reliability of ultrasound in identifying reflux nephropathy in children with acute pyelonephritis with or without vesicoureteric reflux (VUR). Methods Eighty children (45 female and 35 male, age range 5 months to 10 years, average age 2 years 1 month) with a positive history for at least one episode of APN participated in this study. All children underwent voiding cystourethrography, DMSA scintigraphy 4 to 8 months after the most recent episode of APN, and an ultrasound test evaluation less than 2 months after DMSA scintigraphy. Results Voiding cystourethrograms showed VUR in 52 children (68%); 13 of these were bilateral, for a total of 65 refluxing kidney units of the 154 (42%) evaluated; DMSA scintigram was normal for 108 of 154 kidneys (70%). Of the 65 kidneys with VUR, DMSA scintigram displayed normal findings in 29 cases (45%) and pathologic findings in 36 (55%). In the 79 nonrefluxing kidneys, DMSA scintigram was normal in 69 cases (87%). The relative risk of scarring in VUR kidneys is 2.6. The ultrasound study recorded a maximum longitudinal diameter between the 5th and 95th percentiles in 80 of 89 (81%) kidneys without VUR and in 21 of 65 (32%) with VUR. A significant correlation was found between maximum longitudinal diameters and DMSA scintigraphic findings in kidneys with VUR and those without VUR, respectively. Conclusion This study establishes that ultrasound scans, by means of a simple and reproducible measurement technique, maximum longitudinal diameter, have a predictive value with regard to the presence of scars, with few exceptions. This finding, in our opinion, could lead to a decrease in the number of invasive procedures, in particular DMSA scan, in patients with APN.     

Mothers' coping in chronic childhood illness: the effect of presymptomatic diagnosis of vesicoureteric reflux

AIMS OF THE STUDY WERE TO: Assess coping strategies of mothers who have a child with vesicoureteric reflex (VUR), determine mothers' understanding of VUR before and after diagnosis, assess mothers' perceived needs for support when coping with their child's VUR and compare the above aims between two groups of mothers of children with VUR. BACKGROUND: Vesicoureteric reflex (VUR) is a chronic, congenital, asymptomatic condition which when combined with urinary tract infection (UTI) can result in reflux nephropathy (RN), contributing to 20% of kidney transplants. Unfortunately, VUR is not usually diagnosed until after proven UTI, by which time RN has often developed. However, recent research, the familial ureteric reflux study (FURS) identified for the first time VUR in a cohort of new-borns investigated because of family history. Early detection and prompt treatment of UTI in the presence of VUR may significantly reduce the development of RN but this requires extreme vigilance by mothers, who are usually the primary carers. DESIGN: As mothers' experiences and perceptions were the focus, a qualitative design using semistructured, in-depth interviews was used. After obtaining ethical approval, mothers of 15 children with VUR diagnosed presymptomatically (i.e. after participation in the FUR study) and mothers of 14 children with VUR diagnosed post symptomatically were selected using a theoretical sampling matrix. All mothers gave informed consent and interviews were taped, transcribed and analysed using the 'Framework' technique. FINDINGS: Findings for both groups fall into three discrete phases: the prediagnostic, diagnostic and postdiagnostic. Analysis showed that mothers in the post symptomatic diagnosis group experienced most problems in coping, particularly because of difficulty in engaging medical intervention in the prediagnostic phase. Generally, mothers in the presymptomatic group coped well apart from those who themselves had VUR and/or RN who expressed guilt about their child inheriting the condition and consequently difficulty in coping. CONCLUSION: Early diagnosis of VUR improved mothers' coping. However, both groups identified a major need for improved information provision and support to assist coping with the sustained uncertainty of the condition.     

首诊泌尿道感染患儿影像学检查评价与分析

目的通过对首次就诊的UTI患儿核素肾皮质显像、肾脏B超等影像检查结果进行分析比较,从而探讨小儿UTI影像学检查的策略。方法研究对象为224例首次就诊的UTI患儿,在1周内进行99Tcm-DMSA肾皮质显像及肾脏超声检查评价是否有肾实质感染,一到两周内进行膀胱输尿管显像以评价VUR。结果经DMSA显像证实121例(54%)存在肾实质感染,其中8人伴肾瘢痕形成;103例(46%)DMSA显像正常。以DMSA肾显像为诊断标准,B超检查评价肾实质感染的灵敏度为53.72%。在肾实质感染患儿中,41%存在膀胱输尿管返流。100个发生损害的肾脏,48%存在膀胱输尿管返流;而92个未发生损害的肾脏,有1个存在中度VUR。在有肾瘢痕的UTI患儿中,75%存在膀胱输尿管返流。对VUR分度及肾损害分级进行等级相关分析,发现肾损害分级程度越重,VUR分度越高。结论对首诊的UTI患儿,临床上怀疑肾实质感染者,应行DMSA显像以准确评价肾损害程度,B超检查可作为筛查及补充手段;DMSA显像提示肾损害或有反复尿路感染者,尤其是有瘢痕形成的UTI患儿,行VUR检测十分必要,并建议3~6个月后随访DMSA显像,以检测是否发生肾瘢痕。     

The necessity of voiding cystourethrography in children with prenatally diagnosed hydronephrosis

The postnatal persistence of fetal hydronephrosis requires further evaluation to establish whether pathological abnormalities are present. This study determined the necessity for voiding cystourethrography (VCUG) to identify vesicoureteral reflux (VUR) in children (n = 195) with prenatally diagnosed hydronephrosis. Among the study population, the prevalence of VUR was 17.4% (24 males, 10 females). There was a poor correlation between the severity of hydronephrosis, ureteral dilatation, presence of bilateral hydronephrosis and presence of VUR. Except for the frequency of urinary tract infections and the presence of renal damage on (99m)Tc-dimercaptosuccinic acid scans, VCUG was the only reliable method for confirming VUR in this study. The diagnosis of VUR is important for the early detection of renal damage. Further information is needed to develop the optimal approach to the evaluation of prenatal hydronephrosis, with reliable parameters that avoid invasive procedures such as VCUG.     

Immature ureteric jet doppler patterns and urinary tract infection and vesicoureteric reflux in children

The Doppler waveform of the ureteric jet is the result of modification of ureteric peristalsis by an active sphincteric mechanism of the vesicoureteric junction (VUJ). The monophasic pattern is associated with immaturity. This study set out to see the correlation between this immature pattern with urinary tract infection (UTI) and vesicoureteric reflux (VUR) in children. Ureteric jets of 241 healthy children and 98 children with UTI were studied. The monophasic pattern was found in 29% of healthy children overall, but varied greatly according to age. The monophasic pattern was virtually universal in the first 6 months of life, dropping to below 15% in late childhood. This immature pattern was more commonly seen in the UTI (73.5%) and VUR (90.5%) groups than in the healthy controls. The difference was statistically significant (p = 0.0005 for both). The persistence of this immature pattern was highly associated with UTI and VUR.     

Asian guidelines for urinary tract infection in children

The followings are the level of evidence (LE) and grade of recommendation (GR) on pediatric UTI in Asia. Classification according to the sites of infection (lower versus upper tract), the number of episode (first versus recurrent), the severity (simple versus severe), or the existence of complicating factor (uncomplicated versus complicated) is useful to differentiate children with UTI whether they are at risk of renal damage or not (LE: 2, GR: B). Diagnosis of UTI requires both urinalysis that suggests infection and positive urine culture (LE:3, GR B). For pre-toilet trained children, urine specimen for culture should be collected by urethral catheterization or suprapubic aspiration. For toilet trained children, midstream clean catch urine is reliable (LE: 3, GR: A). Urine culture is considered positive if it demonstrates growth of a single bacterium with the following colony counts: (1) any growth by suprapubic aspiration, (2) >5 × 104 CFU/ml by urethral catheterization, or (3) >100,000 CFU/ml by midstream clean catch (LE:3, GR: B). For children with febrile UTI, renal and bladder ultrasonography (RBUS) should be routinely performed as soon as possible (LE: 3, GR: C). RBUS should be followed up 6 months later in children with acute pyelonephritis and/or VUR (LE: 3, GR: C). Acute DMSA scan can be performed when severe acute pyelonephritis or congenital hypodysplasia is noted on RBUS or when the diagnosis of UTI is in doubt by the clinical presentation (LE: 3, GR: C). Late DMSA scan (>6 months after the febrile UTI) can be performed in children with severe acute pyelonephritis, high-grade VUR, recurrent febrile UTIs, or abnormal renal parenchyma on the follow-up RBUS (LE: 3, GR: C). Top-down or bottom-up approach for febrile UTI is suggested for the diagnosis of VUR. For top-down approach, VCUG should not be performed routinely for children after the first febrile UTI. VCUG is indicated when abnormalities are apparent on either RBUS or DMSA scan or both (LE: 2, GR: B). VCUG is also suggested after a repeat febrile UTI (LE:2, GR: B).Appropriate antibiotic should be given immediately after urine specimen for culture has been obtained (LE:2, GR: A). Initiating therapy with oral or parenteral antibiotics is equally efficacious for children (>3 months) with uncomplicated UTI (LE: 2: GR: A). The choice of empirical antibiotic agents is guided by the expected pathogen and the local resistance patterns (LE: 2, GR: A). For children with febrile UTI, the total course of antibiotic therapy should be 7–14 days (LE: 2, GR: B). Circumcision may, but not definitively, reduce the risk of febrile UTI in males and breakthrough febrile UTI in males with VUR. Circumcision should be offered to uncircumcised boys with febrile UTI and VUR in countries where circumcision is accepted by the general population (LE: 3, GR: B), while in countries where childhood circumcision is rarely performed, other measures for febrile UTI/VUR should be the preferred choice (LE: 4, GR: C). Bladder bowel dysfunction (BBD) is one of the key factors of progression of renal scarring (LE: 2). Early recognition and management of BBD are important in prevention of UTI recurrence (LE:2, GR: A). Antibiotic prophylaxis to prevent recurrent febrile UTI is indicated in children with moderate to high grade (III–V) VUR (LE: 1b, GR: A). Surgical intervention may be used to treat VUR in the setting of recurrent febrile UTI because it has been shown to decrease the incidence of recurrent pyelonephritis (LE: 2, GR: B).     

Intrarenal Reflux

Vesicoureteral reflux (VUR) is a childhood condition that is usually diagnosed by fluoroscopic voiding cystourethrography (VCUG). Intrarenal reflux (IRR) of infected urine is believed to play an important role in the pathogenesis of reflux‐associated pyelonephritis and subsequent parenchymal scarring and is traditionally depicted by fluoroscopic VCUG. This case series describes the phenomenon of IRR occurring in association with VUR in 4 children as depicted by contrast‐enhanced voiding urosonography. The ability of contrast‐enhanced voiding urosonography to show IRR when it occurs in conjunction with VUR compares favorably to that of fluoroscopic VCUG.     

Association between the imaging characteristics of renal abscess and vesicoureteral reflux

IntroductionRenal abscesses are rare in pediatric populations. We aimed to highlight the differences in the computed tomography (CT) imaging characteristics of renal abscesses in patients with and without vesicoureteral reflux (VUR).Materials and methodsThirteen children with renal abscesses were included and categorized into those with and without VUR. Blood and urine culture results were recorded as positive or negative. Imaging characteristics were recorded: with/without subcapsular fluid collection, with/without upper/lower pole involvement, and with single/multiple lesions in kidneys. Fisher's exact test was used for intergroup comparisons of the rate of positive pathogens and imaging characteristics.ResultsNine patients had VUR (45.9%). Blood and urine culture were positive in two (15.4%) and seven cases (53.8%), respectively. There was no significant difference in the rate of pathogen-positive blood and urine cultures (blood culture positive/negative status with VUR vs. that without VUR = 2/7 vs. 0/4, p > 0.999, urine culture positive/negative status with VUR vs. that without VUR = 4/5 vs. 3/1, p = 0.559). The two groups differed significantly regarding subcapsular fluid collection presence (with/without subcapsular fluid collection with VUR vs. that without VUR = 9/0 vs 1/3, p = 0.014). There was no significant difference in upper/lower pole involvement (with/without involving upper/lower pole with VUR vs. that without VUR = 8/1 vs 2/2, p = 0.203). Patients with VUR were non-significantly more likely to have multiple lesions compared to those without VUR.ConclusionsVUR was associated with subcapsular fluid collection and possibly with multiple lesions, indicating the need for prompt detection of and specific treatment for VUR in cases with these findings.