机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流

目的探讨机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流的可行性、安全性和手术技巧。方法回顾性分析2014年5月至2019年2月上海市儿童医院收治的11例原发性膀胱输尿管反流患儿临床资料,其中男童10例,女童1例,均应用达芬奇系统辅助腹腔镜行Lich-Greqoir输尿管再植手术。患儿平均年龄9.4岁(3.2~18岁)。其中双侧4例,单侧7例。反流程度Ⅱ~Ⅳ级(Ⅱ级2侧,Ⅲ级3侧,Ⅳ级10侧)。结果患儿均采用Lich-Gregoir术式,术中患侧输尿管平均直径9 mm(5~15 mm),平均黏膜下隧道长度4.4 cm(3~6 cm)。术中无中转开放手术,单侧输尿管手术平均时间152 min(132~175 min),双侧输尿管手术平均时间257 min(249~264 min),术后平均住院时间4.5 d(3~6 d),1例双侧VUR患儿术后出现短期尿潴留,延长留置导尿管2周后痊愈。患儿平均随访时间2.5年(6个月至5.3年),所有病例均无发热性尿路感染,B超均未见患侧输尿管肾盂积水加重。术后完成VCUG 9例(其中双侧4例,单侧5例),其中1例双侧病例术后发现左侧反流Ⅰ级。结论机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流安全、有效,可以应用于3岁以上儿童的治疗。     

序贯悬吊在腹腔镜Lich-Gregoir术治疗儿童原发性膀胱输尿管反流中的应用

目的探讨序贯悬吊法在腹腔镜Lich-Gregoir手术治疗儿童原发性膀胱输尿管反流(primary vesicoureteral reflux,VUR)中的安全性和有效性。方法回顾性分析电子科技大学医学院附属妇女儿童医院2017年4月至2018年4月采用序贯悬吊法辅助完成腹腔镜Lich-Gregoir手术治疗儿童原发性膀胱输尿管反流的14例患儿临床资料。14例患儿均因反复尿路感染入院,男5例,女9例;平均年龄36个月,范围9~72个月;右侧8例,左侧6例。术前Ⅲ级反流3例,Ⅳ级或Ⅴ级反流11例,肾图提示存在肾瘢痕。结果14例患儿均在腹腔镜下顺利完成手术,无中转开腹者。平均手术时间为45 min,范围40~63 min;术中平均出血量3.5 ml,范围2~8 ml。术后3个月复查排泄性尿路造影检查,仅1例为Ⅰ级反流,余均未见反流,术后6个月泌尿系超声造影检查、术后9个月排泄性膀胱尿道造影(voiding cystourethrography,VCUG)检查均未见有反流。术后6个月复查肾图未发现新的肾瘢痕出现。14例患儿随访至今无尿路感染发生。结论腹腔镜Lich-Gregoir手术操作中采用腹壁序贯悬吊法,能安全有效的暴露术野,并缩短切开膀胱浆肌层和包埋输尿管的操作时间。     

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.     

腹腔镜Lich-Gregoir术与开放Cohen术治疗儿童原发性膀胱输尿管反流的疗效分析

目的探讨腹腔镜Lich-Gregoir术与开放Cohen术在儿童原发性膀胱输尿管反流(vesicoureteral reflux, VUR)治疗中的应用价值。方法本研究为回顾性研究, 将2018年6月至2022年6月首都医科大学附属北京儿童医院接受手术治疗的150例原发性VUR且资料完整的患儿纳入研究。按照手术方式的不同分为腹腔镜Lich-Gregoir组(n=69)和开放Cohen组(n=81);根据VUR侧别的不同以及术中是否行输尿管裁剪, 将腹腔镜Lich-Gregoir组进一步分为单侧未裁剪输尿管腹腔镜Lich-Gregoir组(A组, n=33)、双侧未裁剪输尿管腹腔镜Lich-Gregoir组(C组, n=16)、单侧裁剪输尿管腹腔镜Lich-Gregoir组(E组, n=12)、双侧裁剪一侧输尿管腹腔镜Lich-Gregoir组(G组, n=8), 开放Cohen组进一步分为单侧未裁剪输尿管开放Cohen组(B组, n=30)、双侧未裁剪输尿管开放Cohen组(D组, n=20)、单侧裁剪输尿管开放Cohen组(F组, n=18)、双侧裁剪一侧输尿管开放Cohen组(H组...     

气膀胱腹腔镜在膀胱输尿管连接处狭窄性畸形中的临床应用

目的 探讨气膀胱腹腔镜下输尿管再植术治疗膀胱输尿管连接处狭窄性畸形的手术效果.方法 45例膀胱输尿管连接处梗阻患儿共61根输尿管均采用气膀胱腹腔镜下Cohen再植术,男26例,女19例.12根输尿管术中裁剪,9根输尿管术后留置双J管.所有病例术后均留置导尿管.结果 2例中转开放手术,其余都在气膀胱下顺利完成.手术时间单侧平均为3.5 h(2～8 h),重肾输尿管平均为3.7 h(3.5～4.5 h),双侧平均为5.4 h(3.5～9 h).术后导尿管留置平均6.7d(4～13d),静脉使用抗生素平均6.2 d(4～13 d),术后住院平均8.3 d(5～14d)出院.35例(77.8％)48侧术后获得B超随访,随访时间为1～67个月,平均19.3个月.B超显示绝大部分肾盂宽度及输尿管扩张情况较术前明显好转.1例(2.2％)术后半年因泌尿系感染检查发现输尿管扩张明显,再次手术后好转.9例(20％)术后进行DTPA肾动态显像,分肾功能较术前增高或维持原状.14例(31.1％)22侧行MCU检查,3例出现术后反流,1例出现对侧反流.结论 气膀胱腹腔镜手术在治疗膀胱输尿管连接处狭窄性畸形方法上可行,手术成功率较高,随访肾盂及输尿管扩张情况明显好转,膀胱输尿管连接处梗阻解除.     

腹腔镜下膀胱外输尿管膀胱再植术治疗儿童输尿管膀胱连接部异常21例报告

目的 探讨腹腔镜下膀胱外输尿管膀胱再植术治疗儿童输尿管膀胱连接部异常的临床疗效.方法 回顾性分析我院2014年10月至2016年1月用腹腔镜膀胱外输尿管膀胱再植术治疗21例输尿管膀胱连接部异常患儿的临床资料.其中输尿管膀胱连接部狭窄14例,输尿管膀胱连接部反流3例,输尿管异位开口4例.术前检查包括泌尿系统超声检查、泌尿系统CT三维重建成像检查、排泄性膀胱尿道造影和肾图检查.所有患儿术前检查均提示输尿管全程扩张,有反复尿路感染史14例,伴发肾积水9例,输尿管全程扩张达20 mm以上者6例,术前肾图结果提示异常者10例.结果 21例均经腹腔镜完成手术,无中转开放.手术时间120～170 min.术后4例出现轻度肉眼血尿,1d后消失.术后平均住院时间为8d,所有患儿术后无尿潴留发生,无吻合口漏发生.术后随访3～12个月,有2例发生尿路感染(9.5％),1例予口服抗生素及多饮水后缓解,1例抗感染治疗无效后,膀胱镜下取出双J管后缓解.术前肾图11例正常,10例患侧异常,术后3个月异常者有8例复查肾图,较术前有改善,失访2例.术后3～6个月超声复查输尿管直径均小于6mm.结论 腹腔镜下膀胱外输尿管膀胱再植术治疗儿童输尿管膀胱连接部异常疾病安全有效,术中用时合理、出血少,膀胱创伤小,肾功能有明显改善,临床疗效确切,且具有微创优势.     

气膀胱腹腔镜输尿管移植术

目的介绍应用气膀胱腹腔镜（pneumovesicoscopy）行Cohen输尿管移植术的体会。方法2002年11月-2004年12月治疗11例患儿，年龄3个月～11岁，平均4．4岁。男5例，女6例。膀胱输尿管反流8例（双侧3例，重复肾重复输尿管反流1例），输尿管末端狭窄输尿管全程扩张2例，重复肾上半肾积水输尿管扩张输尿管囊肿1例，总共16根输尿管。手术方法：经膀胱镜注CO2气体扩张膀胱，膀胱镜观察下在脐下以带针缝线经皮穿透膀胱全层做牵引线，鞘管（trocar）沿牵引线穿刺插入膀胱与牵引线固定。同法两侧放置操作鞘管。经中线鞘管目镜观察，两侧鞘管操作。同开放手术行Cohen输尿管移植。术后不放输尿管支撑管仅留置导尿管。结果11例手术均获得成功，无中转开放。手术时间120-300min，平均213min。术后5～7d拔除导尿管出院。术后随访2～14个月，10例无尿路感染发生，尿常规检查正常，其中3例随访，MCU检查原4～5级反流消失。1例出现吻合口狭窄伴尿路感染，予保守治疗控制感染成功。结论在熟练掌握腹腔镜分离缝合技术基础上。气膀胱腹腔镜手术行Cohen输尿管移植术可取得良好的手术效果。     

气膀胱下Politano-Leadbetter输尿管移植术的经验分析

目的总结气膀胱腹腔镜下Politano-Leadbetter输尿管移植术的经验。方法回顾性分析厦门市妇幼保健院小儿外科2018年1月至2018年7月收治的10例输尿管膀胱连接部异常患儿临床资料,患儿均采用气膀胱腹腔镜下Politano-Leadbetter术治疗。其中男童6例,女童4例;年龄1.76～24个月,平均6.9个月。膀胱输尿管连接部狭窄4例,右侧2例,左侧2例;膀胱输尿管反流6例,单侧2例,双侧4例。手术方法:常规建立气膀胱,膀胱镜下置入腹腔镜及操作器械,膀胱内游离输尿管后,应用尿道口-输尿管开口-新输尿管裂孔三点一线原理,准确寻找膀胱外输尿管。自新的裂孔将输尿管重新迁入膀胱,再向原输尿管口建立黏膜下隧道。结果 10例均经气膀胱下完成手术,无一例中转开放手术。单侧手术时间100～185 min,平均131 min;双侧手术时间115～205 min,平均174 min。术中几乎无明显出血。术后8 d拔除尿管后无一例出现排尿困难、切口感染和切口裂开,住院时间7～15 d。10例均获随访,随访时间6～12个月,均无尿漏、膀胱输尿管反流、输尿管膀胱连接部梗阻等并发症发生。结论气膀胱腹腔镜下行Politano-Leadbetter术成功率高,能保留原始输尿管的开口位置与解剖走向,是小儿输尿管移植术可行的微创手术方式。     

Appplication of end-to-side ureteroureweterostomy via incision of inguinal striae in children with complete duplication anomalies

目的 评价经腹股沟皮纹切口输尿管端侧吻合术治疗儿童完全性重肾畸形的手术疗效.方法 从2008年1月至2010年12月间用同侧输尿管端侧吻合术治疗完全性重肾畸形患儿16例(17侧),女14例,男2例,年龄为4个月至12岁.患儿主要表现发热性尿路感染或正常排尿间歇滴尿等症状.经术前影像学检查明确输尿管囊肿8例,膀胱输尿管反流8例,输尿管开口异位5例(1例为双侧).其中上输尿管囊肿同时存在反流3例,上输尿管囊肿伴下输尿管反流2例,单纯输尿管囊肿3例,单纯下输尿管反流2例,1例上输尿管曾作过再植手术后仍存在反流.结果 所有患儿手术过程顺利,平均手术操作时间60 min,术后平均住院5d.术后患儿发热性尿路感染或滴尿等症状消失,经术后3～6个月超声、同位素肾图等检查,患肾功能改善,反流消失,肾积水缩小,吻合口无梗阻.结论 经腹股沟皮纹切口输尿管端侧吻合术治疗重肾畸形输尿管囊肿、反流及开口异位是一种合适方法.手术操作过程简单、省时,腹股沟皮纹切口美观,此外,手术创伤小,并发症少,缩短了住院时间,还可作为重肾输尿管手术后再次手术的方法.     

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。     

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     

Renal ultrasound findings and vesicoureteral reflux in children hospitalised with urinary tract infection

Aims: To determine the sensitivity, specificity, and predictive values of renal ultrasound findings for vesicoureteral reflux (VUR). Methods: Retrospective review of the ultrasound and voiding cystourethrogram (VCUG) results of 162 children under 5 years of age admitted with their first episode of urinary tract infection (UTI) over a two year period. Ultrasound findings were considered suggestive of VUR if "dilatation of the pelvi-calyces", "dilatation of the ureters", or "dilatation of the collecting system" of one or both kidneys was reported. Results: A total of 162 patients were eligible for inclusion (median age 85 days; 71 (44%) were female). The prevalence of VUR was 22%. Ultrasound findings were positive for VUR in 14 of 35 patients with confirmed VUR on VCUG, and positive in 30 of 127 patients without VUR on VCUG. Of 21 patients who had a normal ultrasound but showed VUR on VCUG, 14 had grade II reflux, five grade III reflux, and two grade IV reflux. The sensitivity and specificity of ultrasound in suggesting VUR were 40% and 76%, respectively. The positive predictive value of ultrasound in suggesting VUR was 32%; the negative predictive value was 82%. Conclusion: Renal ultrasound findings are neither sensitive nor specific for VUR in children with a first UTI.     

Renal ultrasound findings and vesicoureteral reflux in children hospitalised with urinary tract infection.

AIMS: To determine the sensitivity, specificity, and predictive values of renal ultrasound findings for vesicoureteral reflux (VUR). METHODS: Retrospective review of the ultrasound and voiding cystourethrogram (VCUG) results of 162 children under 5 years of age admitted with their first episode of urinary tract infection (UTI) over a two year period. Ultrasound findings were considered suggestive of VUR if "dilatation of the pelvi-calyces", "dilatation of the ureters", or "dilatation of the collecting system" of one or both kidneys was reported. RESULTS: A total of 162 patients were eligible for inclusion (median age 85 days; 71 (44%) were female). The prevalence of VUR was 22%. Ultrasound findings were positive for VUR in 14 of 35 patients with confirmed VUR on VCUG, and positive in 30 of 127 patients without VUR on VCUG. Of 21 patients who had a normal ultrasound but showed VUR on VCUG, 14 had grade II reflux, five grade III reflux, and two grade IV reflux. The sensitivity and specificity of ultrasound in suggesting VUR were 40% and 76%, respectively. The positive predictive value of ultrasound in suggesting VUR was 32%; the negative predictive value was 82%. CONCLUSION: Renal ultrasound findings are neither sensitive nor specific for VUR in children with a first UTI.     

Cohen再植术后反流影响因素的研究

目的 通过回顾性研究Cohen术围手术期各变量值,分析影响Cohen术后反流因素.方法 回顾性研究及追踪随访2008年1月至2013年12月我院收治的原发性膀胱输尿管反流(VUR)及原发性膀胱输尿管交界处梗阻(POM)患儿,排除继发反流及梗阻患儿,设置围手术期各个变量,对各变量进行统计学分析,找寻影响Cohen术后反流因素.结果 共随访218例原发VUR及POM,排除2例术中输尿管折叠再植术,1例术后出现对侧反流,1例术侧产生梗阻并发症.共纳入研究214例,其中VUR 74例,POM 140例.平均年龄3.7岁(7个月至17岁),平均手术时间72.3 min(60～95 min),平均出血5.5ml,随访时间6～53个月.19例患儿术后产生反流的并发症,其中11例通过保守治疗好转,8例通过再次Cohen术治愈,术后无反流率91.1％,最终手术成功率96.3％.经统计学检验发现在手术年龄7个月至17岁、输尿管黏膜下埋植长度与直径比2.5～7情况下,手术成功率与性别、年龄、病种、单双侧、反流度数、裁剪、埋植长度、埋植直径、埋植长度与直径比、支架管留置时间,导尿管留置时间、术前输尿管直径、术前泌尿系感染(UTI)无关(P＞0.05);输尿管黏膜下长度与直径比以≥5与＜5分成两组,两组手术成功率也无差异(P＞0.05).结论 在7个月至17岁、输尿管黏膜下埋植长度与直径比2.5～7情况下,Cohen术后反流与围手术期各个因素无关,即在此年龄段输尿管黏膜下埋植长度与直径比≥2.5即可起到抗反流作用.     

Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: A single-centre 5-year experience

PurposeTo evaluate our results with a new method of intravesical ureteric reimplantation using laparoscopic pneumovesicum in children.Materials and methodsSeventy-two patients (mean age 4.2 years, range 0.5–20 years) with primary vesicoureteral reflux (VUR) underwent a laparoscopic transtrigonal ureteric reimplantation with CO₂ pneumovesicum. Ports were inserted suprapubically – 5 mm for the camera and two 3–5-mm working ports. Having mobilized the ureter(s) intravesically, a submucosal tunnel is created and ureteric reimplantation performed with 5/0 and 6/0 absorbable sutures. Bladder drainage was maintained for 2–3 days postoperatively. Patients were followed up with clinical assessment and renal ultrasonography ± voiding cystourethrogram.ResultsNinety percent had VUR grade ≥3. A total of 113 ureters were reimplanted. The mean operative time was 82 min for unilateral and 130 min for bilateral reimplantation. Four cases (6%) were converted. Three patients presented with temporary ureteric dilatation without symptoms on follow-up renal ultrasound. Seven patients had postoperative urinary tract infection without persistent reflux on cystography. Follow-up cystogram was performed in 50 patients (81 ureters). Reflux persisted in four patients (8%).ConclusionsLaparoscopic ureteric reimplantation with CO₂ pneumovesicum is technically feasible with a high success rate (92%). The role of this new technique in the treatment of VUR remains to be determined.     

Detection of low-grade vesicoureteral reflux in children by color Doppler imaging mode

Vesicoureteral reflux (VUR) is common in children with urinary tract infections (UTI) and may result in renal scarring or reflux nephropathy. To date, the primary diagnostic tool has been voiding cystourethrography (VCUG). A new technique for evaluation of grade 1 and 2 VUR is described using color Doppler imaging-mode cystography (CDIMC): 77 children, aged 7 months to 14 years, were examined for VUR by CDIMC and standard VCUG. According to the established reflux sonography (US) using a real-time mode, all patients selected for this study had a normal urinary tract on conventional gray-scale US. We studied 154 ureters, and a total of 31 were found to be refluxing on CDIMC and 30 on VCUG. A positive sonogram was defined as visualization of Doppler signals from the bladder to the ureter during the course of bladder filling. Taking VCUG as the gold standard, we had ten false-positive findings. The false-positive rate of 18.5% may have been due to the shorter observation time of fluoroscopy. Comparison of the two methods shows CDIMC to be 70% sensitive with a specificity of 92% in the detection of VUR grade 1 and 2. To evaluate the incidence of asymptomatic low-grade VUR in a non-infected population, a second series of 38 children (19 males, 19 females) aged 3 to 15 years (mean 8.8 years) with normal urologic status and urine cultures were studied by color Doppler imaging mode (CDIM) for detection of asymptomatic low-grade VUR. Four children were found to have a unilateral refluxing ureter. The incidence of VUR in children with a normal urinary tract and no prior UTI was 10.5%. In conclusion, CDIMC can be used as a possible alternative to standard VCUG for the screening and follow-up of low-grade VUR. In addition, our study indicates that asymptomatic grade 1 and 2 reflux might be a physiological condition.     

Comparison of direct radionuclide cystography and voiding cystourethrography in detecting vesicoureteral reflux

BACKGROUND: Fluoroscopic voiding cystourethrography (VCUG) is a widely used imaging test for the diagnosis of vesicoureteral reflux (VUR). However, high gonadal radiation and intermittent imaging are the main disadvantages of VCUG. Direct radionuclide cystography (DRC) has been advocated for the detection of VUR with increased sensitivity and low radiation doses, however, having the disadvantage of providing less anatomical details for urethral evaluation. In this study, DRC has been compared with standard fluoroscopic VCUG for detection of VUR. METHODS: A total of 41 children (82 kidney ureter units, KUU) aged 1 month-126 months (median, 15 months) were studied sequentially using DRC and VCUG. The indications of VUR studied were urinary tract infection in 29 children, VUR follow up in eight children and antenatal dilatation history in four children. RESULTS: A total of 18 refluxing ureters were detected by DRC, 22 refluxing ureters by VCUG and 14 refluxing ureters by both methods. The two methods were concordant for the detection and exclusion of VUR in 85% of KUU. VUR was missed by VCUG in four KUU (three severe, one mild) whereas VUR was missed by DRC in eight KUU (four grade I, four grade III). CONCLUSIONS: There was a good correlation between DRC and VCUG in the evaluation of VUR. DRC provides continuous monitoring and low gonadal radiation exposure. DRC can be used in the diagnosis of VUR as an alternative to VCUG in selected cases.     

Imaging the urinary tract in children with urinary tract infection

Aim: To evaluate whether ultrasonography (US) alone is sufficient in imaging the urinary tract in 1185 children with urinary tract infection (UTI). Methods: The reports on US and voiding cystourethrography (VCUG) were reviewed. Results: Initial US was normal in 861/1185 patients (73%). VCUG revealed abnormal findings in 285/861 (33%), of which grade III–V vesicoureteral reflux (VUR) comprised 97 cases (11%). During follow‐up, VUR had resolved in 88/97 (91%) patients: in 50/57 (88%) patients without active treatment for VUR, in 27/29 (93%) with endoscopic and in 11/11 (100%) with open surgery for VUR. During follow‐up, 11/97 patients (11%) had developed new renal scarring detectable in US, but no renal impairment occurred. Except for VUR, VCUG showed nonobstructive urethral valves in two infant boys with normal initial US. Thus, in 861 children with normal initial US, 40 patients with grade III–V VUR and two patients with significant nonreflux pathology may have benefited from surgical treatment, giving the total number of possibly missed pathological finding in 42/861 (4.9%) cases if VCUG had not been performed. Conclusion: We suggest that children with UTI could be examined using US alone and to use VCUG only after additional indications.