Priti K, Rao K L N, Menon P, Singh N, Mittal B R, Bhattacharya A, Mitra S K
Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, 160 012, Chandigarh, India.
Pediatr Surg Int. 2004 Feb;20(2):136-9. doi: 10.1007/s00383-003-1107-1. Epub 2004 Jan 24.
This is a prospective study of 20 cases of posterior urethral valves (PUV) presenting between the ages of 12 days and 5.5 years (median 15 months) in order to determine the incidence and progress of vesicoureteric reflux (VUR), hydronephrosis (HN), and renal functional status. The efficacy of fulguration as the sole modality of treatment for PUV was assessed in terms of improvement or disappearance of VUR over a 6-month follow-up period. VUR was present in 60% of the patients, being unilateral in 41.7%. Out of 19 renal units with VUR, reflux subsided in 31.5% by 3 months and 78.94% by 6 months. The blood urea and serum creatinine levels, which were raised in 50% of the patients at presentation, came down to normal by 6 months in all the cases. Improvement in glomerular filtration rates (GFR) was noted in all the children at each follow-up and was found to be statistically significant ( p<0.01). HN was present in all the patients at presentation and was bilateral in 90%. It decreased significantly during the follow-up period, though its complete disappearance was seen only in one case. Vesicoureteric reflux dysplasia syndrome (VURD) was present in two cases. Our study showed that VUR disappeared in a majority of the cases by 6 months once adequate urethral patency was restored, although hydronephrosis persisted.
这是一项对20例年龄在12天至5.5岁（中位年龄15个月）之间的后尿道瓣膜（PUV）患者进行的前瞻性研究，目的是确定膀胱输尿管反流（VUR）、肾积水（HN）的发生率和进展情况以及肾功能状态。在6个月的随访期内，根据VUR的改善或消失情况评估电灼作为PUV唯一治疗方式的疗效。60%的患者存在VUR，其中41.7%为单侧。在19个存在VUR的肾单位中，3个月时31.5%的反流消失，6个月时78.94%的反流消失。就诊时50%的患者血尿素和血清肌酐水平升高，所有病例在6个月时均降至正常。在每次随访时，所有儿童的肾小球滤过率（GFR）均有改善，且具有统计学意义（p<0.01）。所有患者就诊时均存在HN，90%为双侧。在随访期间HN显著减轻，不过仅1例完全消失。2例患者存在膀胱输尿管反流发育不良综合征（VURD）。我们的研究表明，一旦恢复足够的尿道通畅性，大多数病例中的VUR在6个月时消失，尽管肾积水仍然存在。
