Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg and Department of Pediatrics, Children's University Hospital (IS), Lund, Sweden.
J Urol. 2010 Jul;184(1):298-304. doi: 10.1016/j.juro.2010.03.063. Epub 2010 May 20.
We investigated the prevalence and types of lower urinary tract dysfunction in children with vesicoureteral reflux grades III and IV, and related improved dilating reflux, renal damage and recurrent urinary tract infection to dysfunction.
A total of 203 children between ages 1 to less than 2 years with reflux grades III and IV were recruited into this open, randomized, controlled, multicenter study. Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done at study entry and 2-year followup. Lower urinary tract function was investigated by noninvasive methods, at study entry with 4-hour voiding observation in 148 patients and at 2 years by structured questionnaire and post-void residual flow measurement in 161.
At study entry 20% of patients had lower urinary tract dysfunction, characterized by high bladder capacity and increased post-void residual urine. At 2 years there was dysfunction in 34% of patients. Subdivision into groups characteristic of children after toilet training revealed that 9% had isolated overactive bladder and 24% had voiding phase dysfunction. There was a negative correlation between dysfunction at 2 years and improved dilating reflux (p = 0.002). Renal damage at study entry and followup was associated with lower urinary tract dysfunction at 2 years (p = 0.001). Recurrent urinary tract infections were seen in 33% of children with and in 20% without dysfunction (p = 0.084).
After toilet training a third of these children with dilating reflux had lower urinary tract dysfunction, mainly voiding phase problems. Dysfunction was associated with persistent reflux and renal damage while dysfunction at study entry did not predict the 2-year outcome.
我们研究了膀胱输尿管反流（VUR）等级 III 和 IV 的儿童中下尿路功能障碍的发生率和类型，以及相关的改善扩张性反流、肾损伤和复发性尿路感染与功能障碍的关系。
本研究为一项开放、随机、对照、多中心研究，共纳入 203 例年龄在 1 岁以下至 2 岁以下、反流等级为 III 和 IV 的儿童。在研究入组时和 2 年随访时进行排尿性膀胱尿道造影和二巯丁二酸闪烁显像。在研究入组时，148 例患者通过非侵入性方法进行下尿路功能检查，4 小时排尿观察，在 2 年时通过结构化问卷和排尿后残余尿量测量进行检查。
在研究入组时，20%的患者存在下尿路功能障碍，表现为膀胱容量高和排尿后残余尿量增加。2 年后，34%的患者存在功能障碍。按照已接受如厕训练的儿童分组，发现 9%的患者有孤立性逼尿肌过度活动，24%的患者有排尿期功能障碍。2 年后功能障碍与改善扩张性反流呈负相关（p = 0.002）。研究入组和随访时的肾损伤与 2 年后的下尿路功能障碍相关（p = 0.001）。复发性尿路感染见于 33%的有功能障碍的儿童和 20%的无功能障碍的儿童（p = 0.084）。
在接受如厕训练后，这些扩张性反流的儿童中有三分之一存在下尿路功能障碍，主要是排尿期问题。功能障碍与持续性反流和肾损伤相关，而研究入组时的功能障碍并不能预测 2 年的结果。
