Barthold J S, Martin-Crespo R, Kryger J V, Gonzalez R
Department of Urology, Children's Hospital of Michigan, Detroit, USA.
J Urol. 1999 Sep;162(3 Pt 2):1193-6. doi: 10.1016/S0022-5347(01)68128-X.
Quantitative nuclear cystography has been advocated as a tool for determining the prognosis in children with primary vesicoureteral reflux. We reviewed our data on this technique to assess its usefulness for predicting the outcome in this population.
We retrospectively reviewed the records of all patients with primary reflux in whom findings were positive on at least 2 nuclear cystograms at our institution between 1992 and 1997. Patients followed at least 3 years were stratified according to outcome. Unfavorable prognostic criteria included bladder volume at reflux onset 60% or less of total bladder capacity and calculated volume of reflux 2% or greater of bladder capacity.
Of the 107 patients in our study 63 were followed for 3 years or longer, and reflux resolved in 17, was repaired in 24 and persisted in 22. Mean patient age at latest followup, duration of followup and number of cystograms did not significantly differ among groups. Intermittent reflux in 33% of the patients followed 3 years or longer was not associated with outcome or detrusor instability. Bladder and reflux volume varied and was nonpredictive in individuals.
Quantitative nuclear cystography did not predict the outcome in patients followed for primary vesicoureteral reflux at a single institution for 3 years or longer. Intermittent reflux was common. These data suggest that nuclear cystography cannot be used to assess reliably the prognosis in individuals. Strong consideration should be given to using negative findings on 2 cystograms to confirm reflux resolution in patients at high risk.
定量膀胱核素造影已被推荐作为确定原发性膀胱输尿管反流患儿预后的一种工具。我们回顾了关于该技术的数据，以评估其对预测该人群预后的有用性。
我们回顾性分析了1992年至1997年间在我们机构至少进行过2次膀胱核素造影且结果呈阳性的所有原发性反流患者的记录。随访至少3年的患者根据预后进行分层。不良预后标准包括反流开始时膀胱容量占膀胱总容量的60%或更少，以及计算得出的反流容量占膀胱容量的2%或更多。
在我们研究的107例患者中，63例随访了3年或更长时间，其中反流消失17例，行修复手术24例，持续存在22例。各组间最新随访时的平均患者年龄、随访时间和膀胱核素造影次数无显著差异。随访3年或更长时间的患者中有33%出现间歇性反流，这与预后或逼尿肌不稳定无关。膀胱和反流容量各不相同，对个体无预测价值。
在单一机构对原发性膀胱输尿管反流患者进行3年或更长时间的随访中，定量膀胱核素造影不能预测预后。间歇性反流很常见。这些数据表明，膀胱核素造影不能可靠地用于评估个体的预后。对于高危患者，应充分考虑利用2次膀胱造影的阴性结果来确认反流消失。
