McMillan Zeb M, Austin J Christopher, Knudson Matthew J, Hawtrey Charles E, Cooper Christopher S
Division of Pediatric Urology, Department of Urology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
J Urol. 2006 Oct;176(4 Pt 2):1838-41. doi: 10.1016/S0022-5347(06)00619-7.
Reflux grade is the factor most commonly used to predict spontaneous reflux resolution. We evaluated other potential predictive factors aside from reflux grade relative to spontaneous resolution.
We reviewed the records of 20 males and 98 females who were diagnosed with primary vesicoureteral reflux between ages 0 and 7 years between 1990 and 2000. Age, sex, height, weight, reflux grade, bladder volume at onset of reflux and laterality were recorded for the first, second and most recent voiding cystourethrogram or nuclear cystogram before spontaneous resolution or operative intervention.
Of 118 patients 75 (64%) had spontaneous resolution, 27 (23%) underwent corrective surgery and 16 (13%) are still being followed. Average age at diagnosis was 2.3 years (range 1 day to 7.7 years) and average followup was 4.3 years (range 0.2 to 14). Average time to spontaneous resolution was 2.2 years (range 0.5 to 10.3) vs a time to operative treatment of 3.6 years (range 0.2 to 11.2). There was a significantly higher spontaneous resolution rate for lower reflux grades (p = 0.0004). Reflux occurring at greater than 75% of predicted bladder capacity had a significantly higher resolution rate (p = 0.0005). The initial height and weight percentile was not significant for predicting spontaneous resolution. Breakthrough urinary tract infections were negative predictors of spontaneous resolution (p <0.0001).
In addition to grade, bladder volume relative to predicted bladder capacity at the onset of reflux appears to provide additional prognostic information regarding the likelihood of spontaneous resolution of primary vesicoureteral reflux.
反流分级是预测自发性反流消退最常用的因素。我们评估了除反流分级之外与自发性消退相关的其他潜在预测因素。
我们回顾了1990年至2000年间年龄在0至7岁之间被诊断为原发性膀胱输尿管反流的20名男性和98名女性的记录。记录了自发性消退或手术干预前第一次、第二次和最近一次排尿性膀胱尿道造影或核素膀胱造影时的年龄、性别、身高、体重、反流分级、反流开始时的膀胱容量及部位。
118例患者中，75例（64%）自发性消退，27例（23%）接受了矫正手术，16例（13%）仍在随访中。诊断时的平均年龄为2.3岁（范围1天至7.7岁），平均随访时间为4.3年（范围0.2至14年）。自发性消退的平均时间为2.2年（范围0.5至10.3年），而手术治疗时间为3.6年（范围0.2至11.2年）。较低反流分级的自发性消退率显著更高（p = 0.0004）。反流发生时大于预测膀胱容量75%的患者，其消退率显著更高（p = 0.0005）。初始身高和体重百分位数对预测自发性消退无显著意义。突破性尿路感染是自发性消退的负性预测因素（p <0.0001）。
除分级外，反流开始时相对于预测膀胱容量的膀胱容量似乎能提供有关原发性膀胱输尿管反流自发性消退可能性的额外预后信息。
