尿路感染与原发性膀胱输尿管反流

目的 了解儿童尿路感染中原发性膀胱输尿管反流的发生情况。方法 62例尿路感染患儿行排泄性膀胱尿路造影，诊断原发性膀胱输尿管反流并分级，以做相应治疗。结果 膀胱输尿管反流在尿路感染住院患儿中比例为40.32％。结论 儿童尿路感染的住院患儿，尤其反复发作者，存在原发性膀胱输尿管反流比例较大。     

神经性膀胱输尿管反流治疗对策的探讨

目的探讨神经性膀胱患儿输尿管反流的治疗措施。方法脊膜修补术后神经性膀胱并输尿管反流患儿45例,男29例,女16例,年龄4～14岁。排泄性膀胱尿道造影(VCUG)示膀胱输尿管反流左侧19例,右侧11例．双侧15例,其中Ⅰ°-Ⅲ°12例(15条),Ⅲ°-Ⅴ°33例(45条)。Ⅰ°-Ⅱ°中,5例(7条)仅行清洁间歇导尿,7例(8条)行保留膀胱黏膜肠浆肌层膀胱扩大术；Ⅲ°-Ⅴ°中,9例(12条)仅行间歇导尿。24例(33条)行保留膀胱黏膜肠浆肌层膀胱扩大术,其中19例(28条)同时行Lich-Gregoir手术,术后配合间歇导尿。结果6个月后随访,Ⅰ°-Ⅱ°15条中,7条行清洁间歇导尿,3条反流消失(42．9%),8条行保留膀胱黏膜肠浆肌层膀胱扩大术者,6条反流减轻或消失(75．0%)；Ⅲ°-Ⅴ°45条中,12条行间歇导尿者,10条反流程度进一步加重,5条单纯行膀胱扩大术者,2条反流减轻或消失(40．0%),28条同时行Lich-Gregoir手术者,23条反流减轻或消失(82．1%)。结论神经性膀胱输尿管反流的治疗方法取决于输尿管反流的程度。Ⅰ°-Ⅱ°单纯行膀胱扩大术,也可考虑只行清洁间歇导尿；Ⅲ°-Ⅴ°反流须在行膀胱扩大术的同时行输尿管抗反流术,术后配合间歇导尿。     

原发性膀胱输尿管反流及反流性肾病的影像学诊断

原发性膀胱输尿管反流是输尿管膀胱交界区的先天性异常。目前国内此病报道较少，现就我们近年遇到的16例原发性膀胱输尿管反流报告如下。材料与方法一、一般资料本组16例中男11例，女5例，年龄lmo～10a，平均3a。病史数天到6a。主要临床表现为尿频、尿急等反复泌尿系感染11例．     

小儿原发性膀胱输尿管反流的临床研究

目的　探讨小儿原发性膀胱输尿管反流的发病机制、临床特点、肾损害评价、治疗及预后。方法　回顾性研究 1990～ 2 0 0 2年复旦大学附属儿科医院 5 0例小儿原发性膀胱输尿管反流 ,对反流程度、尿路感染、肾疤痕形成、尿液分析及血管紧张素转化酶 (ACE)基因型进行了分析 ,并将药物和手术治疗组的随访结果进行比较。结果　 5 0例中双侧反流者 2 2例 (44 % ) ,单侧反流者 2 8例 (5 6 % ) ;39例行膀胱尿道造影检查发现反流Ⅰ度2 9 5 % (2 3/ 78) ,Ⅱ度 7 7% (6 / 78) ,Ⅲ度 14 1% (11/ 78) ,Ⅳ度 4 1 0 % (32 / 78) ,Ⅴ度 7 7% (6 / 78)。尿液 β2 微球蛋白、尿视黄醇结合蛋白、N乙酰半胱氨酸异常升高与肾疤痕形成相关 (P <0 0 5 ) ,血ACE基因型ID或DD型与肾疤痕形成相关 (P <0 0 5 )。药物与手术治疗组尿路感染复发率、肾疤痕形成率及反流有效控制率无显著差别。结论　小儿原发性膀胱输尿管反流需要及早诊断 ,同时通过对尿液微量蛋白及血ACE基因型检测 ,对肾损害作出预测 ,建立个体化的有效的治疗方案     

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。     

加强对儿童尿路感染和膀胱输尿管反流的认识

儿童尿路感染是婴儿和儿童中一种常见的细菌性感染,6岁以内儿童泌尿道感染(UTI)累计发病率女孩为6.6%,男孩为1.8%.UTI与膀胱输尿管反流(VUR)的关系复杂,共同存在是导致持续性的肾脏损害和疤痕化的重要因素.UTI诊断明确后最常应用的影像学检查有肾脏和尿路超声检查、排泄性膀胱尿道造影和核素肾静态显像(DMSA),其中DMSA为目前公认的诊断肾瘢痕的金标准.尽管对在不同年龄、性别和临床表现的患儿中如何正确选择相关的影像学检查有较大的争议,但多数推荐对所有2岁以下的儿童进行超声、VCUG和DMSA检查.研究还显示VUR有其一定的遗传基础,在同胞中的发病率显著高于健康儿童.随时间推移发育逐渐成熟,有部分反流可自行痊愈,大都不需要手术治疗.大多数VUR的病例,尤其是5岁以下的儿童建议使用低剂量持续性抗生素预防治疗.反流性肾病长期的并发症是发生终末期慢性肾功能衰竭.     

儿童膀胱输尿管反流的转归预后探讨

膀胱输尿管反流 (vesicouretericreflux ,VUR)是指排尿时尿液从膀胱反流至输尿管和肾盂 ,是婴幼儿反复泌尿道感染的常见原因。部分VUR患儿可自行缓解 ,但是 ,也有部分VUR患儿可引起反流性肾病 (refluxnephropathy ,RN) ,表现为肾脏瘢痕形成、肾生长迟缓、肾功能不全。VUR患儿因反复泌尿道感染常常导致肾功能受损 ,估计 15岁以下儿童每年有 0 3～ 0 4人 / 10 0万人口因RN导致肾衰竭 ,每年有 5～ 10名女孩 / 10 0万人口因RN而进入终末期肾病[1] ,但也有研究认为无症状VURⅠ度及Ⅱ度可能为一生理现象[2 ] 。所以 ,很有必要进一步研…     

腹腔镜Lich-Gregoir手术治疗儿童双侧原发性膀胱输尿管反流

目的 评价腹腔镜Lich-Gregoir手术治疗儿童双侧原发性膀胱输尿管反流治疗效果.方法 对2007年9月至2009年9月4例腹腔镜Lich-Gregoir手术治疗双侧原发性膀胱输尿管反流患儿的临床资料进行回顾性分析.结果 4例患儿,均因反复尿路感染收治.平均年龄6.5岁(5～8岁).男1例,女3例,排尿行膀胱尿道造影(VCUG)均提示双侧VUR,其中Ⅴ级2侧,Ⅳ级3侧,Ⅲ级3侧.二巯丁二酸(DMSA)肾图均证实存在一侧或双侧肾瘢痕.所有病例均经腹腔路径成功于膀胱外完成腹腔镜Lich-Gregoir手术.平均手术时间为200min(140～300min),术中无明显出血,术后平均住院时间6 d(5～7 d).平均随访18.5个月(6～30个月),所有患儿术后6个月VCUG复查证实膀胱输尿管反流均完全消失,无发热性尿路感染及新的肾瘢痕形成.1例患儿术后出现短期尿潴留,留置导尿1周后症状消失.结论 我们的初步经验显示腹腔镜Lich-Gregoir手术安全、有效、创伤小、术后恢复快,有望成为治疗儿童原发性膀胱输尿管反流,尤其是双侧病变较理想的治疗方法.     

Primary vesicoureteral reflux in infants with a dilated fetal urinary tract

Vesicoureteral reflux (VUR) was recognized neonatally by voiding cystography in 25 of 117 infants with a dilated fetal urinary tract. There was a male preponderance (76%) and a high percentage (40%) of associated urinary malformations. Thirtynine refluxing units were studied. All grades of VUR were detected but gross dilating VUR dominated (59%). Spontaneous resolution was excellent in lower grades of VUR but was poor in gross VUR. Surgery was successfully performed in 13 renal units of nine patients with gross reflux [8], additional ipsilateral malformations [4], or pyelonephritis during antibiotic prophylaxis [1]. Segmental renal scars developed in four kidneys after urinary infections, and a diffuse parenchymal lesion was noted in nine kidneys even at birth. One boy with duplication had a non-functioning refluxing system. Our results in a small number of infants show differences to children with VUR detected after urinary infections and seem to support the existence of a congenital reflux nephropathy.     

膀胱输尿管反流的诊疗争议和研究进展

小儿原发性膀胱输尿管反流(vesicoureteric reflux,VUR)与尿路感染、排尿功能障碍相伴发生,常常导致肾疤痕、肾萎缩、高血压、肾功能减退等一系列反流性肾病的表现,重者甚至进展为终末期肾病.目前,随着对VUR治疗经验的累积,在诊断策略及治疗上都出现了一定的争议.无论手术治疗或非手术治疗结果仍不令人满意,VUR的发病机制目前还不清楚,需要进行进一步的研究和探索.     

Treatment of vesicoureteral reflux in children by endoscopic injection of Teflon

From November 1986 to April 1990, 326 refluxing ureters in 197 children were treated by endoscopic injection of Teflon paste. Complications were observed in only 3 cases: 1 child had immediate bilateral ureteral stenosis requiring surgery at 48 h. In 1 case it was impossible to probe 1 ureteral orifice after injection, and Cohen reimplantation was immediately performed; in a 3rd case ureteral dilatation occurred 1 year later without anatomic stenosis at surgery. Three hundred twenty-two ureters were examined after 1 month: reflux had disappeared in 286 (88.82%). The stability of these results after one injection was verified 1 year later for 179 ureters: recurrence of reflux was observed in 19 cases (10.60%); 21 non refluxing ureters were again examined 2 years later: reflux reappeared in 2 cases. Analysis of the midterm results showed that failure was observed in 17.31% of cases of primary reflux and 19.04% of malformative or secondary refluxes. It was more significant in grade IV or V (21.11%) than in grade I–III (16.85%) reflux. Of the 57 immediate or secondary residual refluxes, 10 were followed and 2 spontaneously disappeared, 24 underwent successful surgical reimplantation, and 23 had a repeat injection with 22 successes and only 1 failure that was secondarily cured by surgery. Overall, reflux disappeared after one or two injections in 165 children (83.25%). Offprint requests to: H. Dodat     

Results of surgery for vesicoureteral reflux in children: 6 years' experience in an Asian country

From January 1990 to December 1995, a total of 181 patients underwent reimplantation of 318 ureters for primary vesicoureteral reflux (VUR); 87.8% received bilateral reimplantation. Surgical indications included breakthrough infection (35%), high-grade (≥IV) reflux (33%), or both (29%). The operative success rate was 99.4% at 3 months postoperatively and 100% ultimately. The complications included: contralateral sequential reflux in 3.9%, postoperative bladder diverticula in 1.1%, postoperative urinary infection in 1.1%, residual reflux in 0.3%, postoperative vesicoureteral stenosis in 0.3%, and slippage of the drainage tube in 0.3% of cases. Two patients had renal failure due to VUR that was proven by renal biopsy (one 4-year-old and one 8-year-old). The incidence of associated anomalies was higher than in the normal population. The average number of hospital admission days was 7.9 (3–63). After 1992, no ureteral stent was left in postoperatively. All patients received prophylactic antibiotics for 3 months postoperatively until the VUR disappeared. The surgical results were satisfactory in this series. Accepted: 4 February 1997     

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...     

Endoscopic treatment of vesicoureteral reflux using cross-linked bovine dermal collagen

To assess the efficacy of endoscopic treatment of vesicoureteral reflux (VUR) with cross-linked bovine collagen, 59 patients with grade I through V VUR were evaluated and treated. Follow-up consisted of a voiding cystourethrogram and renal ultrasound at 1 month and 1 year with urinalysis and urine culture. Repeat treatment was carried out in cases in which no resolution of the reflux was noted up to three times. The procedure was performed on an outpatient basis in 56 patients and was not associated with any major morbidity or mortality. Cure at 1 month was observed in 75% of ureters treated; cure persisted in 79% of these ureters at 1 year. The overall cure rate was 65% at 1 year. Given the simplicity of the procedure, its low complication rate, and overall success in the majority of patients, we feel that endoscopic treatment of VUR with cross-linked bovine dermal collagen is a safe and effective method and worthy of further study to enhance its efficacy. Offprint requests to: M. Cendron     

Harmonic voiding urosonography with a second-generation contrast agent for the diagnosis of vesicoureteral reflux

Background  Voiding urosonography with harmonic imaging (VUS HI) has been introduced as a sensitive and radiation-free imaging method for the diagnosis and follow-up of vesicoureteral reflux (VUR) in children. Objective  The purpose of this study was to evaluate the sensitivity of VUS HI using a second-generation US contrast agent compared to standard voiding cystourethrography (VCUG). Materials and methods  A total of 228 children with 463 kidney-ureter units (KUUs) underwent two cycles of VUS HI and two cycles of VCUG at the same session. VUS HI was performed after intravesical administration of 1 ml of a second-generation US contrast agent (sulphur-hexafluoride gas microbubbles, SonoVue, Bracco, Italy). For statistical analysis we used McNemar’s test, Student’s t-test and k coefficient tests. Results  VUR was shown in 161/463 (34.7%) KUUs, 57 by both methods, 90 only by VUS, and 14 only by VCUG. Concordance in findings regarding the presence or absence of VUR was found in 359/463 (77.5%) KUUs (k=0.40). The difference in the detection rate of reflux between the two methods was significant (P<0.01). More importantly, reflux missed by VCUG was of higher grade (2 grade I, 65 grade II, 19 grade III, 4 grade IV) than that missed by VUS (8 grade I, 5 grade II, 1 grade III). Conclusion  VUS HI and a second-generation contrast agent improved the identification of reflux in children. Our data reveal a higher sensitivity of the method compared to VCUG. Thus it can be used as an alternative radiation-free imaging method.