排泄性尿路超声造影在儿童膀胱输尿管反流诊断中的研究进展

膀胱输尿管反流（VUR）与儿童泌尿道感染密切相关。排泄性尿路超声造影（CeVUS）是诊断儿童VUR的一种安全且可靠的影像学检查方法。本文主要就CeVUS在评估儿童VUR方面的研究进展做一综述。     

小儿尿路感染与原发性膀胱输尿管反流的关系

目的探讨小儿尿路感染与原发性膀胱输尿管反流的关系。方法78例尿路感染患儿经肾脏超声、静脉肾盂造影及排泄性尿路造影检查明确诊断，并给予相应治疗。结果膀胱输尿管反流在尿路感染患儿中占26％，在反复尿路感染患儿中占69％。结论原发性膀胱输尿管反流是小儿尿路感染的易感因素之一。     

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。     

腹膜外腹腔镜膀胱外输尿管膀胱再植术的临床应用

[目的]探讨经腹膜外径路腹腔镜下膀胱外输尿管膀胱再植术临床应用的可行性.[方法]应用腹膜外腹腔镜下膀胱外黏膜下隧道式抗反流输尿管膀胱再植术(Lich-Gregoir改良术)治疗10例输尿管出口梗阻患者,其中5例为单纯先天性输尿管末端狭窄;2例为巨输尿管症;3例为重复肾输尿管末端狭窄(2例为双侧性).[结果]10例均获得成功,无中转开放手术.单侧手术时间(107±22)min,出血量(49±16)mL,住院时间(5.8±1.1)d,术后无一例发生并发症.随访3～12个月,B超、静脉肾盂造影和(或)磁共振尿路成像显示肾积水或输尿管扩张明显好转或消失,排泄性膀胱尿道造影观察无一例发生膀胱输尿管反流.[结论]腹膜外径路腹腔镜下膀胱外黏膜下隧道式抗反流输尿管膀胱再植术方法简单、创伤小、并发症少、恢复快、抗反流效果好,值得临床推广.     

48例儿童排泄性膀胱尿路造影检查术的护理

目的:总结排泄性膀胱尿路造影的护理方法.方法:回顾性分析2009年3月至2011年8月广东省中山市博爱医院小儿肾内科进行排泄性膀胱尿路造影检查48例患儿的临床护理资料.结果:48例患儿均顺利完成造影检查,造影过程中无不良反应及意外事件发生.结论:精心、细致的护理是儿童排泄性膀胱尿路造影顺利完成的有效保证.     

输尿管口囊肿的内镜切开,开窗术

内镜手术为输尿管口囊肿的治疗开辟了新的途径。该组１０例单纯性输尿管口囊肿经内镜切开，开窗术治疗，效果满意。术后随访，梗阻解除且无膀胱输尿管返流讨论了Ｂ超，排泄性尿路造影和膀胱镜检的诊断价值，并介绍了术中应用利尿剂的体会，提出了内镜操作的要点及预防返流的方法。     

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。     

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。     

尿路造影对神经源性膀胱的诊断价值

目的探讨尿路造影对神经源性膀胱的诊断价值。方法回顾性分析神经源性膀胱的X线表现，所有病例均行静脉肾盂造影或膀胱造影检查。结果膀胱不同程度扩张，容积增大，边缘光整，或膀胱壁不光整呈多发大小不一憩室，呈“松塔”或“圣诞树”样改变，可有双侧或单侧输尿管返流伴输尿管、肾盂积水。结论本病发病原因及病理改变各不相同，影像表现基本相同，尿路造影可明确诊断。     

儿童常用泌尿系影像学检查的护理

儿童常用泌尿系影像学检查的护理２１００１１南京医科大学第二附属医院王惠敏我院小儿外科自１９８５年１月至１９９４年１２月收治儿童泌尿系外科疾病（不包括尿道下裂）５６例，采用Ｂ型超声（简写Ｂ超）、排泄性静脉尿路造影（简写ＩＶＰ）、排尿性膀胱尿道造影（简写...     

Potential causes of insufficient bladder contrast opacification and premature microbubble destruction during contrast-enhanced voiding urosonography in children

Contrast-enhanced voiding urosonography (ceVUS) has been recognized as a child-friendly examination with high diagnostic accuracy for vesicoureteric reflux detection. A single bolus and the infusion techniques of ceVUS are described. Insufficient bladder contrast opacification during the filling phase and premature destruction of SonoVue microbubbles might occur. Data regarding SonoVue's features, doses, bladder contrast opacification, US bladder parameters, urine catheter, antibiotic prophylaxis, and childrens behaviors were collected to discover the possible causes of the contrast vanishing observed during bladder filling in 10% of examinations and in the later phase of ceVUS in 5% of examinations. An updated ceVUS examination protocol is suggested.     

Usefulness of echocystography in the study of vesicoureteral reflux.

The aim of our study was to assess the usefulness of contrast-enhanced sonography in detecting and staging vesicoureteral reflux in pediatric patients. Forty-nine children between birth and 5 years of age were studied for vesicoureteral reflux. Echocystography with the use of an endovesical signal enhancer was performed first, followed immediately by conventional voiding cystourethrography. The findings obtained by echocystography and voiding cystourethrography were consistent in 89 (90.8%) of 98 ureterorenal units (a ureterorenal unit is 1 kidney with its own ureter). Reflux was demonstrated by voiding cystourethrography in 13 cases; in 9 of these cases diagnosis had also been made by echocystography. Five cases of reflux detected by echocystography were not identified by voiding cystourethrography. With voiding cystourethrography as the standard of reference, sensitivity was 69%; specificity, 94%; positive predictive value, 64%; and negative predictive value, 95%. In conclusion, echocystography is a useful tool for the diagnosis of vesicoureteral reflux. Its ability to detect reflux is similar to that of cystography in cases of high-grade reflux, and it may be an appropriate complementary technique to voiding cystourethrography, because it avoids exposure to radiation.     

A Low-Cost,Durable and Re-Usable Bladder Phantom: Teaching Intravesical Ultrasound Contrast Administration

Contrast-enhanced voiding urosonography (ceVUS) is a radiation-free and highly sensitive examination for detecting vesicoureteral reflux and imaging the urethra in children. This examination is performed with ultrasound and intravesical administration of a gas-filled microbubble US contrast agent. The U.S. Food and Drug Administration recently approved the use of a US contrast agent for ceVUS in children. Because of the growing interest among physicians and US technologists in using ceVUS in children, a urinary bladder phantom was developed to teach intravesical ultrasound contrast administration to perform ceVUS procedures. Described here are the preparation and utility of a low-cost, durable and re-usable phantom that simulates the administration, distribution and effects of different US parameters on US contrast agent appearance in the bladder during ceVUS in children.     

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.     

Vesicoureteral reflux in young patients: Comparison of voiding color Doppler US with echo enhancement versus voiding cystourethrography for diagnosis or exclusion

We assessed the accuracy of voiding color Doppler ultrasonography (US) with echo enhancement for diagnosis or exclusion of vesicoureteral reflux (VUR) versus voiding cystourethrography (VCUG) and evaluated patient tolerance of the echo-enhancing agent. One hundred twenty-two patients (ages range, 1 month to 17 years) with 244 ureterorenal units underwent voiding color Doppler US with echo enhancement, which was followed by VCUG on the same day. After US of the urinary tract, the bladder was filled with saline solution via catheter. Then an echo-enhancing agent was instilled, and color Doppler US was performed. Reflux was diagnosed when microbubbles appeared in the ureter or the pelvicaliceal system. VUR was detected in 98 units. All grades of reflux were identified. In 13 units (13.3%), grade I reflux diagnosed at voiding color Doppler US was not observed at VCUG. No reflux was detected in 146 units by either method. In 231 (94.2%) of the 244 ureterorenal units, there was concordance between the two methods. The echo-enhancing agent was well tolerated by all patients. Voiding color Doppler US with echo enhancement is useful for the diagnosis or exclusion of VUR, being as good as VCUG. Therefore, it may reduce the number of patients exposed to ionizing radiation.     

Helping children with dysfunctional voiding

Children with dysfunctional voiding display a variety of symptoms including urinary urgency, frequency, and incontinence. Urinary tract infections and vesicoureteral reflux are not uncommon in this population. An accurate diagnosis of the underlying voiding dysfunction guides treatment, which may include a combination of behavioral, biofeedback, and medical interventions. Nurses play a key role in helping children and families understand the nature of voiding problems, implementing treatment regimens, monitoring progress, and keeping children on track. Various types of dysfunctional voiding in children, their evaluation, and management strategies are described.     

Vesicovaginal reflux mimicking obstructive hydrocolpos.

OBJECTIVE: The purpose of this study was to describe a series of cases of hydrocolpos that proved to be due to vesicovaginal reflux. METHODS: Cases with a diagnosis of hydrocolpos or a fluid-filled vagina identified from our ultrasound database were retrospectively reviewed. The results from sonographic and fluoroscopic studies were reviewed, along with demographic and clinical data. RESULTS: Four patients had sonographic findings mimicking obstructive hydrocolpos that resolved after voiding. Fluoroscopic studies showed abnormal urethral morphologic characteristics in all 4, diminished bladder capacity in 3, and vesicovaginal reflux in 3. No anatomic abnormalities were identified. CONCLUSIONS: Vesicovaginal reflux can produce vaginal distension that is sonographically identical to obstructive hydrocolpos. This may be due to dysfunctional voiding issues. Postvoid sonography allows proper diagnosis.     

Significance of endoscopy for evaluation of vesico-ureteral reflux.

The role of urethrocystoscopy in the evaluation of vesico-ureteral reflux is discussed. In addition to voiding cystourethrograms and excretory urography endoscopic examination of patients with vesico-ureteral reflux permits the determination of the extent of the uretero-vesical junction malformation. The length of the submucosal ureter, the orifice configuration and its location as well as the trigonal muscular development are parameters which lend themselves to endoscopic evaluation. Their importance in the decision of whether vesico-ureteral reflux is treated conservatively or surgically is discussed. In addition, urethrocystoscopy may give valuable information on the causes of secondary vesico-ureteral reflux.     

Some Electrocardiographic Manifestations of Digitalis

The normal urinary tract is protected from infection both by its ability to empty itself and by its intrinsic defense mechanisms. If micturition is abnormal or if reflux occurs, the defense mechanisms are overwhelmed and infection may become established. Restoration of normal voiding and elimination of reflux will allow eradication of infection.