Department of Urology, University of Iowa, Iowa City, IA 52242-1089, USA.
Nat Rev Urol. 2009 Sep;6(9):481-9. doi: 10.1038/nrurol.2009.150. Epub 2009 Aug 11.
Critical evaluation of previously accepted dogma regarding the evaluation and treatment of vesicoureteral reflux (VUR) has raised significant questions regarding all aspects of VUR management. Whereas the standard of care previously consisted of antibiotic prophylaxis for any child with VUR, it is now unclear which children, if any, truly benefit from antibiotic prophylaxis. Operative intervention for VUR constitutes overtreatment in many children, yet there are limited data available to indicate which children benefit from VUR correction through decreased rates of adverse long-term clinical sequelae. Studies with longer follow-up demonstrate decreased efficacy of endoscopic therapy that was previously hoped to approach the success of ureteroneocystostomy. Prospective studies might identify risk factors for pyelonephritis and renal scarring without antibiotic prophylaxis. Careful retrospective reviews of adults with a history of reflux might allow childhood risk factors for adverse sequelae to be characterized. Through analysis of multiple characteristics, better clinical management of VUR on an individualized basis will become the new standard of care.
对先前关于评估和治疗膀胱输尿管反流（VUR）的既定观念的批判性评估，对 VUR 管理的各个方面提出了重大问题。虽然以前的护理标准是对所有 VUR 患儿进行抗生素预防，但现在尚不清楚哪些患儿（如果有的话）真正从抗生素预防中受益。VUR 的手术干预在许多患儿中属于过度治疗，但可用的数据有限，无法表明哪些患儿通过降低不良长期临床后果的发生率从 VUR 矫正中获益。随访时间更长的研究表明，以前希望达到与肾盂成形术相当成功率的内镜治疗效果降低。前瞻性研究可能会确定无抗生素预防时肾盂肾炎和肾瘢痕形成的风险因素。仔细回顾有反流病史的成年人，可能有助于确定患儿发生不良后果的风险因素。通过对多种特征进行分析，将以个体化为基础更好地对 VUR 进行临床管理，这将成为新的护理标准。
