Narasimhan K L, Chowdhary S K, Kaur Balpinder, Mittal B R, Bhattacharya A
Department of Pediatric Surgery, Post-Graduate Institute, PGIMER, Chandigarh, UT 160 012, India.
J Pediatr Urol. 2006 Dec;2(6):569-74. doi: 10.1016/j.jpurol.2005.12.003. Epub 2006 Feb 24.
To retrospectively review the occurrence of renal scarring in patients with posterior urethral valves (PUV), and correlate it with various causative factors.
The records of 52 patients treated for PUV by the authors were reviewed. Patients with vesico-ureteric reflex (VUR) dysplasia syndrome were excluded from the study. The patients were divided into group I (no renal scarring, n=18) and group II (renal scars present, n=34) based on dimercapto-succinic acid scans. The mode of treatment, presence/absence of breakthrough urinary tract infections (UTI), presence/absence of history of nocturnal/diurnal incontinence, presence/absence of VUR, stable postoperative serum creatinine, rate of drainage of ureters on diethylene triamine penta acetic acid (DTPA) scans and management of bladder dysfunction, if any, were noted. The presence or absence of renal scarring was statistically correlated with occurrence of any of the above factors.
Primary valve fulguration was performed in 41 patients and 11 patients had an initial vesicostomy. The median follow up was 3.5 years (range 1.5-15 years). Renal scarring was present in either kidney in 34 patients (bilateral 14, unilateral 20). The mode of initial treatment did not affect the incidence or rate of scarring. The preoperative and postoperative serum creatinine at the end of 1 year did not differ between the two groups. Presence/severity of VUR did not affect the pattern of renal scarring. A highly significant correlation between the occurrence of renal scarring and presence of diurnal incontinence (P< or =0.007, odds ratio=4.5) and breakthrough UTI (P< or =0.002, odds ratio=7.0) was observed. There was also correlation with slow drainage in the ureters on a DTPA scan (P< or =0.0005). Detrusor instability and low compliance on urodynamic assessment did not affect occurrence in the limited number of patients studied. The rate of somatic growth in both groups was retarded as compared to normal healthy counterparts.
Breakthrough UTI, diurnal incontinence and poor drainage of ureters on DTPA are associated with a higher incidence of renal scarring. Mode of initial treatment, presence or absence of VUR, and bladder abnormalities do not affect renal scarring in the short term.
回顾性分析后尿道瓣膜症（PUV）患者肾瘢痕形成情况，并将其与各种致病因素相关联。
回顾作者治疗的52例PUV患者的记录。膀胱输尿管反流（VUR）发育异常综合征患者被排除在研究之外。根据二巯基琥珀酸扫描结果，将患者分为I组（无肾瘢痕，n = 18）和II组（有肾瘢痕，n = 34）。记录治疗方式、是否存在突破性尿路感染（UTI）、是否有夜间/日间尿失禁史、是否存在VUR、术后血清肌酐是否稳定、二乙三胺五乙酸（DTPA）扫描时输尿管引流率以及膀胱功能障碍的处理情况（如有）。肾瘢痕的有无与上述任何因素的发生进行统计学关联。
41例患者进行了原发性瓣膜电灼术，11例患者最初进行了膀胱造瘘术。中位随访时间为3.5年（范围1.5 - 15年）。34例患者一侧或双侧肾脏存在肾瘢痕（双侧14例，单侧20例）。初始治疗方式不影响瘢痕形成的发生率或比例。两组患者术后1年末的术前和术后血清肌酐无差异。VUR的存在/严重程度不影响肾瘢痕形成模式。观察到肾瘢痕形成与日间尿失禁的存在（P≤0.007，优势比 = 4.5）和突破性UTI（P≤0.002，优势比 = 7.0）之间存在高度显著相关性。DTPA扫描时输尿管引流缓慢也与之相关（P≤0.0005）。在有限数量的研究患者中，尿动力学评估显示的逼尿肌不稳定和低顺应性不影响发生率。与正常健康同龄人相比，两组患者的身体生长速度均减慢。
突破性UTI、日间尿失禁和DTPA扫描时输尿管引流不畅与肾瘢痕形成的发生率较高相关。初始治疗方式、VUR的有无以及膀胱异常在短期内不影响肾瘢痕形成。
