Zerati Filho Miguel, Calado Adriano A, Barroso Ubirajara, Amaro Joao L
Division of Urology, Sao Paulo State University, UNESP, Botucatu, Sao Paulo, Brazil.
Int Braz J Urol. 2007 Mar-Apr;33(2):204-12; discussion 213-5. doi: 10.1590/s1677-55382007000200012.
We evaluated clinical characteristics of primary vesicoureteral reflux (VUR) in infants in a 30-year period in Brazil with special reference to the relation of renal parenchymal damage to urinary tract infection and gender.
From 1975 through 2005, 417 girls (81.6%) and 94 boys (18.4%) with all grades of reflux were retrospectively reviewed. Patients were categorized by the worst grade of reflux, maintained on antibiotic prophylaxis and underwent yearly voiding cystourethrography until the reflux was resolved. VUR was considered resolved when a follow-up cystogram demonstrated no reflux. Surgical correction was recommended for those who fail medical therapy, severe renal scarring or persistent VUR.
Grades I to V VUR resolved in 87.5%, 77.6%, 52.8%, 12.2% and 4.3%, respectively. Renal scars were present at presentation in 98 patients (19.2%). Neither gender nor bilaterality versus unilaterality was a helpful predictor of resolution. The significant difference was found among the curves using the log rank (p<0.001) or Wilcoxon (p<0.001) test.
Despite the current use of screening prenatal ultrasound, many infants are still diagnosed as having vesicoureteral reflux only after the occurrence of urinary tract infection in our country. Scarring may be associated to any reflux grade and it may be initially diagnosed at any age but half of the scars are noted with higher grades of reflux (IV and V). The incidence of reflux related morbidity in children has significantly diminished over the last three decades.
我们评估了巴西30年间婴儿原发性膀胱输尿管反流（VUR）的临床特征，特别参考了肾实质损害与尿路感染及性别的关系。
回顾性分析了1975年至2005年间417名女孩（81.6%）和94名男孩（18.4%）的所有反流等级情况。患者根据反流的最严重等级进行分类，接受抗生素预防治疗，并每年进行排尿性膀胱尿道造影，直至反流消失。当随访膀胱造影显示无反流时，VUR被认为已消失。对于那些药物治疗失败、严重肾瘢痕形成或持续性VUR的患者，建议进行手术矫正。
I至V级VUR的消失率分别为87.5%、77.6%、52.8%、12.2%和4.3%。98名患者（19.2%）在就诊时存在肾瘢痕。性别以及双侧与单侧反流均不是反流消失的有效预测因素。使用对数秩检验（p<0.001）或威尔科克森检验（p<0.001）发现曲线之间存在显著差异。
尽管目前使用产前超声筛查，但在我国许多婴儿仍在发生尿路感染后才被诊断为膀胱输尿管反流。瘢痕形成可能与任何反流等级相关，且可能在任何年龄首次被诊断，但一半的瘢痕在较高反流等级（IV级和V级）时被发现。在过去三十年中，儿童反流相关发病率显著降低。
