泌尿道感染患儿膀胱输尿管返流和肾瘢痕的发生情况

目的分析不同年龄泌尿道感染儿童膀胱输尿管返流（VUR）和肾瘢痕的发生情况，加强对VUR的认识，提高检出率。方法选择上海交通大学附属新华医院儿科2001年1月-2006年12月因泌尿道感染入院患儿90例，通过排泄性膀胱尿道造影（VCUG）和（或）直接放射性核索膀胱造影（DRNC）明确诊断VUR共40例。分别根据泌尿道感染发生次数及不同年龄，分为首次泌尿道感染和1次以上泌尿道感染组，〉5岁和≤5岁组；分析VUR在首次泌尿道感染和1次以上泌尿道感染组、不同年龄组发病率情况。通过肾静态皮质显像（DMSA）检测肾瘢痕，分析年龄与VUR的级别、肾瘢痕的关系。剖析胎儿超声检查异常、生后VUR和肾瘢痕的发生情况。结果VUR的发病率在首次泌尿道感染和1次以上泌尿道感染组、〉5岁和≤5岁组差异均有统计学意义（X^2=10．627，4．409Pa〈0．05）。年龄与VUR的级别、年龄与肾瘢痕均呈负相关（r=-0．342，-0．348Pa〈0．05）。反复泌尿道感染、≤5岁的泌尿道感染患儿VUR的发生率高。年龄越小发生肾疤痕和高级别VUR的可能性越大。胎儿B超检查显示肾积水患儿，发生高级别VUR和肾瘢痕的可能性大。结论反复泌尿道感染、≤5岁的泌尿道感染患儿、胎儿B超检查显示肾积水的患儿应及时行VCUG和DMSA，及时发现、监测VUR和肾瘢痕。     

小儿膀胱输尿管返流的诊治进展

小儿膀胱输尿管返流（ＶＵＲ）及反流性肾病的病因、病理生理、影像学检查及治疗等方面的研究，近几年有很大进展，但某些方面仍存有争论，有些地方还难以理解，有待深入研究。一、病因小儿ＶＵＲ的病因，已不再认为是单一的输尿管口位置异常的病理过程。反流有种族差异和...     

神经源性膀胱伴输尿管反流的尿动力学研究

目的 探讨有输尿管反流的神经源性膀胱(NB)患儿有或没有逼尿肌过度活动(DO)时的尿动力学差异,为临床治疗此类患儿提供理论参考依据.方法 选取2013～2015年就诊并经影像尿动力学检查发现膀胱输尿管反流的NB患儿68例,男30例,女38例,年龄4～12岁,平均7.5岁.按照充盈期有DO,将其分为DO组(n=20)与无DO组(n=48).观察记录两组发生膀胱输尿管反流时的膀胱灌注量、逼尿肌压并计算发生反流时的膀胱顺应性;记录两组充盈结束时最大膀胱测压容量、最大逼尿肌压、并计算充盈期膀胱顺应性.结果 DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(98.7±16.1)ml和(5.2±1.9) ml/cmH2O,无DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(127.3±36.3)ml,(7.1±2.1)ml/cmH2O,差异均有统计学意义(P＜0.05);两组的逼尿肌压分别为(21.6±9.2)cmH2O、(19.2±7.4)cmH2O,差异没有统计学意义;DO组充盈结束时的膀胱容量与顺应性分别为(182.7±31.2)ml、(5.4±1.7) ml/cmH2O,与无DO组充盈结束时的膀胱容量(230.6±34.6)ml与顺应性(6.5±1.1)ml/cmH2O相比,差异有统计学意义;两组尿动力学检查结束时逼尿肌压分别为(33.8±7.8)cmH2O、(36.4±8.1)cmH2O,差异没有统计学意义.结论 膀胱容量小,膀胱顺应性差是有输尿管反流的NB患儿伴发DO时的尿动力学特征.     

小儿膀胱输尿管反流87例相关尿动力学因素研究

目的 探讨小儿膀胱输尿管反流(vesicoureteric reflux,VUR)的尿动力学表现特点,为小儿VUR的诊断和治疗提供临床参考.方法 选取在郑州大学第一附属医院小儿尿动力学中心就诊的VUR患儿87例(男58例,女29例);年龄4～12岁,平均6岁.另选取因下尿路症状就诊而尿动力学检查无异常且无VUR小儿60例(男38例,女22例)作为对照组;年龄4～12岁,平均6岁.将VUR患儿依据反流的程度分为轻度(Ⅰ度,15例)、中度(Ⅱ度和Ⅲ度,33例)、重度(Ⅳ度和Ⅴ度,39例).尿动力观察参数包括:最大尿流率、残余尿量、最大逼尿肌收缩压力、最大膀胱容量和膀胱顺应性.结果 VUR组的最大尿流率和最大膀胱容量分别为(6.8±6.3)ml/s和(138.5±73.9)ml,均明显低于对照组(16.1±6.7)ml/s和(285.5±107.5)ml,组间比较,差异有统计学意义(P＜0.05).VUR组残余尿量为(95.9±103.4)ml明显高于对照组(9.6±13.9)ml,差异有统计学意义(P＜0.05).VUR组最大逼尿肌压力为(41.6±22.2)cmH2O与对照组(35.1±13.0) cmH2O比较,差异无统计学意义(P-0.229).VUR组男、女童尿动力学参数差异无统计学意义(P＞0.05).VUR组轻度反流(15例)、中度反流(33例)和重度反流(39例)的最大膀胱容量分别为(121.83±69.94) ml、(163.73±80.81)ml和(123.58±68.70) ml,组间比较,差异无统计学意义(P＞0.05).轻度反流组顺应性正常12例(80％),中度反流组12例(36.4％),重度反流组9例(23.1％),三组间差异有统计学意义(P＜0.05).结论 最大尿流率降低、最大膀胱容量减少、残余尿量增多和膀胱顺应性差可能是VUR发生的相关因素.     

小儿膀胱输尿管返流的临床研究

目的　探讨小儿膀胱输尿管返流的临床特征、治疗和预后。方法　对 5 8例小儿膀胱输尿管返流的临床资料进行回顾性研究。结果　原发性膀胱输尿管返流 31例 (5 3 % ) ,继发性返流 2 7例 (4 7% ) ;大多数在婴幼儿期发病 (5 5 % ) ,无特异性临床表现 ;返流越严重 ,肾瘢痕形成率越高 ,蛋白尿及高血压与肾功能损害有关 ;持续小剂量抗菌药物预防性治疗对返流治疗有效率达 71%。结论　早期诊断、及时治疗对小儿膀胱输尿管返流预后十分重要。     

儿童原发性膀胱输尿管返流的诊断与治疗

目的 总结儿童原发性膀胱输尿管返流(PVUR)的诊断与治疗经验.方法 回顾性分析本院近8 a来收治的36例共60侧PVUR患儿的诊治资料,其中1例先行保守治疗,保守治疗无效后行经膀胱内横向黏膜下推进抗返流输尿管膀胱再植术(Cohen手术)治疗,另外35例诊断明确尿路感染控制后均行Cohen手术治疗,术后3～6个月回院复诊,并进行尿常规、排泄性膀胱尿道造影(VCUG)、肾核素扫描等检查,观察治疗效果.结果 经VCUG检查证实35例患儿术后返流消失,其中1例患儿术前双侧Ⅳ度返流、慢性肾功能不全,术后VCUG检查膀胱输尿管无返流,但肾功能无改善,并进一步恶化至尿毒症期,透析替代治疗维持生命;1例双侧患病患儿术后7a复发,再次行Cohen手术治疗,术后6个月复查,效果良好.结论 VCUG检查是诊断PVUR的金标准,Cohen手术治疗儿童PVUR具有创伤小、并发症少、成功率高的优点,是治疗儿童PVUR的经典术式.     

输尿管膀胱吻合术治疗输尿管异位开口

探讨输尿管异位开口的治疗方法。采用输尿管膀胱吻合术治疗１７例。结果：１４例经１－１２年随访，排尿正常，无腰酸痛和其他不适，尿常规和细菌培养均阴性，常规ＩＶＵ检查显示移植输尿管和所属肾段显影良好。结论：本术式是治疗输尿管异位开口的较好方法。     

膀胱输尿管返流患儿尿细胞形态的扫描电镜观察

对膀胱输尿管返流患儿应用扫描电镜观察尿脱落细胞成分和形态变化。结果表明：重度返流组有８８．２％患儿尿中可见多数肾小管上皮细胞，伴肾瘢痕、肾功能异常；泌尿道畸形者可见尿中上皮细胞破裂、坏死脱落与红细胞多数严重变形。轻度返流组则未见上泌尿道脱落细胞。无返流组与对照组的尿细胞成分极少。提示膀胱输尿管返流患儿尿细胞成分变化可反映返流的严重程度与肾内返流的存在，肾实质损伤导致返流性肾病的形成。     

Color Doppler ultrasonography in the assessment of vesicoureteric reflux in children with bladder dysfunction

To determine whether color Doppler ultrasound (DUS) evaluation of ureteric jets could predict vesicoureteric reflux (VUR) in children with non-neuropathic and neuropathic bladder/sphincter dysfunction, 129 children were evaluated to identify the vesicoureteric orifice and measure the distance from the orifice to the midline of the dorsal bladder wall (MVU distance). The type of bladder dysfunction was determined by urodynamic studies. Forty-two children with no history of kidney or bladder disease were examined by DUS as a control group. MVU distances were compared between several groups of children with different urodynamic findings, and the significance was tested. Jets were visualized in 81% of children. MVU distances were significantly lower in children without VUR compared to those with VUR. No statistically significant differences were observed between children without VUR and those with VUR and more severe urodynamic disturbances like dysfunctional voiding. In children with neuropathic bladders, jets were visible in only 57% of refluxive units and the range of MVU distances was very wide (5–22 mm). If a cut-off point of 10 mm is used, in children without bladder dysfunction the sensitivity of MVU measurement in the diagnosis of VUR was 87.5% and the specificity 97%. However, in children with non-neuropathic and neuropathic bladder dysfunction, the sensitivity was only 55% and the specificity 79%. Color Doppler (DUS) and measurement of the MVU distance proved useful in predicting VUR only in children with normal bladder function. In children with neuropathic and non-neuropathic bladder dysfunction it can be used to visualize ureteric jets, but cannot replace radiographic or radionuclide voiding cystourethrography. Accepted: 21 March 2001     

Bladder dysfunction in children with vesico-ureteric reflux

Vesico-ureteric reflux and non-neurogenic bladder dysfunction are closely related, although a causal relationship has been established only for severe forms of detrusor-sphincter dyscoordina-tion. There are several urodynamic studies reporting high frequency of bladder instability and/or detrusor-sphincter dyscoordination in children with reflux. The latter includes an element of functional outflow obstruction and is the most serious, since it accompanies kidney damage. When instability is the only urodynamic abnormality damage is absent. There are indications that treatment of bladder dysfunction increases spontaneous resolution of reflux and, furthermore, that bladder dysfunction is a negative prognostic factor following antireflux surgery. Recently also, gross reflux in infant boys was seen to associate with bladder dysfunction in addition to earlier finding of congenital malformation of the ureterovesical junction. However, no comparisons have emerged on the outcome following treatment of bladder dysfunction and following observation only. In conclusion, children with reflux on chemoprophylaxis prior to reimplantation must always be assessed for bladder dysfunction. This is especially important when there are recurrent urinary tract infections.     

改良Lich-Gregoir手术治疗神经性膀胱输尿管反流的评价

目的　探讨改良Lich Gregoir手术在治疗神经性膀胱输尿管反流中的应用。方法　神经性膀胱并输尿管反流患儿 12例 ,男 8例 ,女 4例 ,年龄 4～ 14岁 ,均为脊膜膨出修补术后。排泄性膀胱尿道造影 (VCUG)示膀胱输尿管反流左侧 5例 ,右侧 3例 ,双侧 4例 ,其中Ⅲ° 4条 ,Ⅳ° 10条 ,Ⅴ°2条。全部行改良Lich Gregoir输尿管抗反流术 ,同时行保留膀胱黏膜肠浆肌层膀胱扩大术。结果　术后 6个月随访 ,VCUG显示 16条反流的输尿管中 ,Ⅲ° 4条反流完全消失 ,Ⅳ°10条中 3条变为Ⅰ°,3条变为Ⅱ° ,1条变为Ⅲ°,3条无明显变化 ,Ⅴ°2条变为Ⅲ°。结论　神经性膀胱逼尿肌压增高 ,导致膀胱输尿管连接部功能失调 ,同时逼尿肌纤维化、膀胱挛缩 ,使得输尿管膀胱壁内段缩短 ,是输尿管反流的重要原因。行改良Lich Gregoir输尿管抗反流术的同时 ,须行膀胱扩大术 ,降低逼尿肌压 ,增加膀胱顺应性。     

膀胱自体扩大术在神经性膀胱患儿中的应用评价

目的评价逼尿肌部分切除、膀胱自体扩大术的临床疗效。方法选择脊髓脊膜膨出患儿6例,其中男性3例,女性3例,年龄18个月至9岁。患儿均口服索利那新和行清洁间歇导尿3个月后无好转而行逼尿肌部分切除、膀胱自体扩大术,术后予清洁间歇导尿,手术前及术后1年行泌尿系超声、排泄性膀胱尿道造影,并行尿动力评价,评价指标为膀胱容量、膀胱顺应性和充盈末逼尿肌压。结果术前尿动力学检查显示6例患儿膀胱容量减小、膀胱顺应性下降及逼尿肌压升高,其中5例膀胱容量低于预期容量的50%。排泄性膀胱造影4例合并膀胱输尿管反流,其中左、右侧Ⅳ°反流各1例,双侧Ⅳ°反流2例。6例患儿手术后恢复顺利,无穿孔、感染发生。术后1年尿动力学检查显示6例患儿膀胱容量略有增加,但膀胱容量与预期膀胱容量(年龄×30+30)、膀胱顺应性及逼尿肌压力无明显变化,VCUG显示4例输尿管反流无减轻。结论对于膀胱容量明显变小的神经性膀胱患儿,逼尿肌部分切除、膀胱扩大术不能有效增加膀胱容量和顺应性,降低逼尿肌压,临床不能取得满意的效果。     

膀胱输尿管反流高危患儿的临床和影像学检查结果分析

目的 对膀胱输尿管反流(VUR)高危患儿的临床表现和排泄性膀胱尿道造影(VCUG)检查结果 进行分析,同时探讨应用无辐射的排泄性尿道超声检查(VUS)对VUR的诊断意义.方法 以2007年7月-2010年4月于首都儿科研究所住院的VUR高危患儿93例为研究对象,包括首次或反复尿路感染58例、无尿路感染但胎儿期或生后B超发现肾积水者35例,所有患儿均行VCUG检查,22例患儿同时接受VUS检查,反流分级采用五级法进行评价.结果 (1)58例尿路感染患儿中发现VUR 20例,检出率为34.5%.反复尿路感染患儿中VUR的检出率明显高于首次尿路感染患儿中VUR的检出率.VUR分布为:≤1岁13例,其中男10例,双侧反流6例,Ⅳ+Ⅴ级反流占57.9%;1～5岁4例,其中男2例,双侧反流1例,Ⅳ+Ⅴ级反流占40.0%;≥5岁3例,其中男1例,双侧反流1例,全部为Ⅲ级以下反流.35例无尿路感染的肾积水患儿中发现VUR 6例,检出率为17.1%.(2)22例患儿同时行VCUG和VUS两种检查,与VCUG相比,VUS诊断VUR的敏感度为100%,特异度为92.1%,阳性预测值66.7%,阴性预测值100%,VUS和VCUG的检出一致性为93.2%.结论 对儿童尤其是低年龄组男童的尿路感染、以及胎儿期或生后B超发现有肾积水的患儿应重视VUR的早期筛查.VUS是一种准确可靠的检查手段,且避免放射暴露,可作为儿童VUR的筛查或追踪观察的方法 之一.

Abstract：

Objective To analyze the clinical data and result of voiding cystourethrography (VCUG)in high-risk children with vesicoureteral reflux(VUR)for better awareness of VUR,and to assess the usefulness of non-radioactive voiding ultrasonography(VUS) in the diagnosis of VUR. Method Ninety-three high-risk children with VUR who were hospitalized from July 2007 to April 2010 were studied.The study included 58 cases of urinary tract infection(UTI)and 35 cases of fetal or postnatal hydronephrosis detected on a B ultrasound scan.The results of urinalysis,urine culture,renal function,B ultrasound and VCUG were evaluated.Part of patients underwent VUS followed by VCUG immediately.Result (1)Sixtytwo boys and 31 girls(aged 1 month to 11.5 years,mean age 2 years)were included.VUR was detected in 26 patients(28%)by VCUG.In terms of kidney-ureter units,VUR was detected in 36 of 186 kidney-ureter units,including 6 grade Ⅰ ,3 grade Ⅱ ,6 grade Ⅲ,15 grade Ⅳ and 6 grade Ⅴ.(2)VUR was detected in 20 of 58 UTI patients(34.5%)by VCUG.The proportion of VUR in recurrent UTI group was 61.1%,much higher than that in first UTI group(22.5%).Thirteen of 20 VUR(65%)occurred in UTI patients under 1 year of age(M/F 10/3),with more bilateral VUR and severe grades of VUR than the older group.VUR was detected in 6 of 35 fetal or postnatal hydronephrosis patients(17.1%)by VCUG.(3)Twentytwo patients underwent both VUS and VCUG.VUR was detected in 4 patients and 6 kidney-ureter units by VCUG,while in 6 patients and 9 kidney-ureter units by VUS.Taking VCUG as the reference standard,VUS     

小儿神经源性膀胱伴膀胱输尿管反流临床特点分析

目的 探讨神经源性膀胱(NB)患儿伴膀胱输尿管反流(VUR)的临床特征,为其临床早期诊断及治疗提供参考依据.方法 收集2014年1月至2019年12月于儿童肾内科收治并诊断为NB伴尿路感染的26例患儿的临床资料,根据有无VUR分为反流组(11例)与无反流组(15例),分析比较两组的临床特点.结果 相比无反流组,反流组患...     

New hydronephrosis and/or vesicoureteral reflux after bladder outlet surgery without augmentation in 75 children with neurogenic bladder

ObjectiveWe report new upper tract changes in children after bladder neck (BN) surgery without augmentation for neurogenic incontinence.Materials and methodsConsecutive children with neurogenic sphincteric incompetency had BN surgery without augmentation. Postoperative renal sonography and fluoroscopic urodynamics were done at 6 months, 12 months, and then annually.ResultsThere were 75 patients with mean follow-up of 48 months. Of these, 17 (23%) developed new hydronephrosis (HN) or vesicoureteral reflux (VUR). All HN resolved with medical management, as did 25% of VUR cases. Persistent VUR was treated by dextranomer/hyaluronic acid injection, or re-implantation in two patients undergoing re-operative BN surgery. There was no association between these upper tract changes and end filling pressures (<40 cm vs. >40 cm) or continence status (dry vs. wet).ConclusionsUpper tract changes developed in 25% of patients with neurogenic bladders after BN surgery without augmentation during a follow-up of 48 months. All new HN and most new VUR resolved with medical management or minimally invasive intervention. No patient developed upper tract changes requiring augmentation.     

Occurrence of reflux in children with ureteral jets

The urograms of 186 boys and 145 girls were scrutinized in order to reveal the incidence of ureteral jets demonstrable during intravenous pyelography (IVP). In this series a unilateral jet was observed in 26 cases and a bilateral jet in 6 cases. Ureteral jets were almost three times as common in patients with normal urograms compared with those revealing urinary abnormalities. The incidence of a positive jet sign, usually unilateral, varies with the employed technique of examination, but the highest incidence in routine IVP seems to be about 30%. Although infrequent, significant ipsilateral vesicoureteral reflux (VUR) may occur. This fact together with the reported low rate of bilateral jets restricts the value of uneteral jets being used as an indicator of absence of gross VUR. The need for micturition cysto-urethography (MCU) at the uro-radiological work-up remains unchallenged.