Upadhyay Jyoti, Bolduc Stéphane, Bagli Darius J, McLorie Gordon A, Khoury Antonie E, Farhat Walid
Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2003 May;169(5):1842-6; discussion 1846; author reply 1846. doi: 10.1097/01.ju.0000058211.24641.66.
Dysfunctional voiding influences the presence and persistence of vesicoureteral reflux. We used a standardized published instrument, the dysfunctional voiding symptom score, to evaluate the association of dysfunctional voiding with vesicoureteral reflux. We report its use for monitoring improvement in and resolution of vesicoureteral reflux.
In 1998, 114 patients with dysfunctional voiding were placed on behavioral modification. Of 58 patients (51%) who presented with urinary tract infection 27 (47%) had abnormal voiding cystourethrography, including 19 with reflux only. Baseline and followup dysfunctional voiding symptom score was determined in these 19 patients, who underwent prospective observational therapy and behavioral modification. We correlated the dysfunctional voiding symptom score with the evolution of vesicoureteral reflux.
Vesicoureteral reflux was present in 19 of the 58 patients (33%) with dysfunctional voiding and urinary tract infection. All affected patients were female with a mean age of 6.7 years and a mean followup of 24 months. Reflux grade in the 24 units was I to IV in 7, 9, 7 and 1, respectively. Mean dysfunctional voiding symptom score was 13.3 in patients with normal voiding cystourethrography and 11.7 in the vesicoureteral reflux group (p = 0.6). Reflux resolved in 3, 2 and 2 cases of grades I, II and III disease, respectively, while improvement (decrease of 2 or more grades) was noted in 4. Initial dysfunctional voiding symptom score in these 11 cases decreased from a mean of 9.6 (range 4 to 18) to 3.7 (range 0 to 12, p = 0.01). The 8 patients with persistent reflux had an initial dysfunctional voiding symptom score of 14.4 (range 4 to 21), which decreased to 11.1 (range 1 to 19, p = 0.18).
A significant decrease in the dysfunctional voiding symptom score appears to confirm compliance with behavioral modification and predicts ultimate reflux resolution. The dysfunctional voiding symptom score provides a noninvasive means of monitoring compliance with therapy during expectant treatment of patients with vesicoureteral reflux.
功能性排尿障碍会影响膀胱输尿管反流的存在及持续情况。我们使用一种标准化的已发表工具——功能性排尿障碍症状评分,来评估功能性排尿障碍与膀胱输尿管反流之间的关联。我们报告其在监测膀胱输尿管反流的改善及消退情况中的应用。
1998年,114例功能性排尿障碍患者接受行为矫正治疗。在58例(51%)出现尿路感染的患者中,27例(47%)排尿性膀胱尿道造影异常,其中19例仅有反流。对这19例患者进行前瞻性观察治疗及行为矫正,并测定其基线及随访时的功能性排尿障碍症状评分。我们将功能性排尿障碍症状评分与膀胱输尿管反流的进展情况进行关联分析。
在58例功能性排尿障碍合并尿路感染的患者中,19例(33%)存在膀胱输尿管反流。所有受影响患者均为女性,平均年龄6.7岁,平均随访24个月。24个单位的反流分级中,I级至IV级分别有7例、9例、7例和1例。排尿性膀胱尿道造影正常的患者平均功能性排尿障碍症状评分为13.3,膀胱输尿管反流组为11.7(p = 0.6)。I级、II级和III级疾病分别有3例、2例和2例反流消退,4例有改善(降低2级或更多级)。这11例患者最初的功能性排尿障碍症状评分从平均9.6(范围4至18)降至3.7(范围0至12,p = 0.01)。8例持续存在反流的患者最初的功能性排尿障碍症状评分为14.4(范围4至21),降至11.1(范围1至19,p = 0.18)。
功能性排尿障碍症状评分显著降低似乎可证实患者对行为矫正的依从性,并预测最终反流消退情况。功能性排尿障碍症状评分为膀胱输尿管反流患者在期待治疗期间监测治疗依从性提供了一种非侵入性方法。