Van Arendonk Kyle J, Madsen Mark T, Austin J Christopher, Hawtrey Charles E, Graham Michael M, Cooper Christopher S
Division of Pediatric Urology, Department of Urology, University of Iowa, Iowa City, Iowa 52242-1089, USA.
Urology. 2007 Apr;69(4):767-70. doi: 10.1016/j.urology.2007.01.048.
The bladder pressure at the onset of reflux may reflect the competence of the ureterovesical junction. The predictive value of the bladder pressure at the onset of vesicoureteral reflux, as measured by nuclear cystometrography, was assessed relative to subsequent reflux resolution.
Nuclear cystometrograms of 67 children were reviewed to determine the presence of reflux, bladder pressure at the onset of reflux, and bladder volume at the onset of reflux. The data were analyzed for significant relationships between the nuclear cystometrogram results and patient outcomes using a Cox proportional hazards regression model, controlling for the duration of follow-up and for patients with bilateral reflux.
Data were gathered for reflux occurring in 85 ureters. As expected, reflux of a greater grade was less likely to resolve spontaneously (P = 0.005). The pressure at the onset of reflux was also highly predictive of spontaneous resolution (P = 0.0005). Reflux occurring at greater pressures was more likely to resolve spontaneously, independent of the reflux grade or bladder volume at the onset of reflux. Patient age (P = 0.45), normalized volume of urine refluxed (P = 0.97), and normalized bladder volume at the onset of reflux (P = 0.18) were not significant predictors of reflux resolution.
The findings of this report have demonstrated for the first time, to our knowledge, that the bladder pressure at the onset of vesicoureteral reflux, as determined by nuclear cystometrography, is a significant independent predictor of vesicoureteral reflux resolution in children.
反流开始时的膀胱压力可能反映输尿管膀胱连接部的功能。通过核膀胱测压法测量的膀胱输尿管反流开始时的膀胱压力对后续反流消退的预测价值进行了评估。
回顾了67名儿童的核膀胱测压图，以确定反流的存在、反流开始时的膀胱压力以及反流开始时的膀胱容量。使用Cox比例风险回归模型分析核膀胱测压图结果与患者预后之间的显著关系，同时控制随访时间和双侧反流患者。
收集了85条输尿管发生反流的数据。正如预期的那样，更高等级的反流自发消退的可能性较小（P = 0.005）。反流开始时的压力对自发消退也具有高度预测性（P = 0.0005）。在更高压力下发生的反流更有可能自发消退，与反流开始时的反流等级或膀胱容量无关。患者年龄（P = 0.45）、反流尿液的标准化体积（P = 0.97）以及反流开始时的标准化膀胱容量（P = 0.18）不是反流消退的显著预测因素。
据我们所知，本报告的研究结果首次表明，通过核膀胱测压法确定的膀胱输尿管反流开始时的膀胱压力是儿童膀胱输尿管反流消退的一个重要独立预测因素。
