Grossklaus D J, Pope J C, Adams M C, Brock J W
Division of Pediatric Urology, Vanderbilt Children's Hospital, Nashville, Tennessee, USA.
Urology. 2001 Dec;58(6):1041-5. doi: 10.1016/s0090-4295(01)01467-4.
To evaluate the patients in our practice to determine whether postoperative cystography was useful in monitoring the outcome after ureteroneocystostomy. Surgical repair of vesicoureteral reflux is the treatment of choice after medical therapy failure. Radiographic evaluation by ultrasonography or voiding cystourethrography (VCUG) is commonly used postoperatively to evaluate for urinary tract obstruction or persistent reflux. However, imaging modalities are not without cost, both in monetary terms and in terms of radiation exposure and trauma to the child.
We reviewed the records of all patients who underwent ureteroneocystostomy without ureteral tapering at our institution between January 1, 1996 and December 31, 1999 for primary vesicoureteral reflux. These records were evaluated with respect to the type of surgical procedure, preoperative and postoperative clinical course, and radiographic studies performed.
We performed reimplantation on 267 renal units in 153 patients. The surgical technique was the Cohen cross-trigonal in 120 renal units (45%), Glenn-Anderson ureteral advancement in 92 (35%), and modified Leadbetter-Politano ureteral advancement in 55 (20%). All patients underwent imaging with ultrasonography within 6 weeks of surgery. The follow-up ranged from 4 to 42 months (average 14.2). Between 3 and 8 months postoperatively, 61 patients underwent imaging with VCUG. We identified persistent reflux in six renal units. Four of six had marked improvement in their reflux. All the patients with persistent reflux were asymptomatic, including 2 patients who were no longer receiving antibiotics. Four patients developed febrile urinary tract infections postoperatively. Three of the four underwent imaging with VCUG after treatment; all three had no evidence of reflux.
In our population, the addition of VCUG to the postoperative evaluation did not allow us to identify those patients at risk of febrile urinary tract infections. Patients in whom persistent reflux was identified were all asymptomatic. We continue to monitor patients with ultrasonography, but believe that VCUG often provides little benefit to these children.
评估我们诊所的患者，以确定术后膀胱造影术在监测输尿管膀胱吻合术后的结果方面是否有用。在药物治疗失败后，膀胱输尿管反流的手术修复是首选治疗方法。术后通常采用超声或排尿性膀胱尿道造影（VCUG）进行影像学评估，以评估是否存在尿路梗阻或持续性反流。然而，无论是在金钱方面，还是在辐射暴露和对儿童的创伤方面，影像学检查都并非没有成本。
我们回顾了1996年1月1日至1999年12月31日期间在我们机构接受输尿管膀胱吻合术且未进行输尿管缩窄的所有原发性膀胱输尿管反流患者的记录。对这些记录进行了手术方式、术前和术后临床过程以及所进行的影像学研究方面的评估。
我们对153例患者的267个肾单位进行了再植术。手术技术为Cohen交叉三角法用于120个肾单位（45%），Glenn-Anderson输尿管推进法用于92个（35%），改良Leadbetter-Politano输尿管推进法用于55个（20%）。所有患者在术后6周内均接受了超声检查。随访时间为4至42个月（平均14.2个月）。术后3至8个月，61例患者接受了VCUG检查。我们在6个肾单位中发现了持续性反流。6例中有4例反流有明显改善。所有持续性反流患者均无症状，包括2例不再接受抗生素治疗的患者。4例患者术后发生发热性尿路感染。其中3例在治疗后接受了VCUG检查；所有3例均无反流证据。
在我们的患者群体中，术后评估增加VCUG并不能使我们识别出有发热性尿路感染风险的患者。发现有持续性反流的患者均无症状。我们继续用超声对患者进行监测，但认为VCUG对这些儿童通常益处不大。
