Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
J Urol. 2010 Jul;184(1):286-91. doi: 10.1016/j.juro.2010.01.061. Epub 2010 May 20.
We evaluated the difference in the febrile urinary tract infection rate in small children with dilating vesicoureteral reflux randomly allocated to 3 management alternatives, including antibiotic prophylaxis, endoscopic treatment or surveillance only as the control.
At 23 centers a total of 203 children were included in the study, including 128 girls and 75 boys 1 to younger than 2 years. Vesicoureteral reflux grade III in 126 cases and IV in 77 was detected after a febrile urinary tract infection (194) after prenatal screening (9). Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. The febrile urinary tract infection rate was analyzed by the intent to treat principle.
We noted a total of 67 febrile recurrences in 42 girls and a total of 8 in 7 boys (p = 0.0001). There was a difference in the recurrence rate among treatment groups in girls with febrile infection in 8 of 43 (19%) on prophylaxis, 10 of 43 (23%) with endoscopic therapy and 24 of 42 (57%) on surveillance (p = 0.0002). In girls the recurrence rate was associated with persistent reflux after 2 years (p = 0.0095). However, reflux severity (grade III or IV) at study entry did not predict recurrence.
In this randomized, controlled trial there was a high rate of recurrent febrile urinary tract infection in girls older than 1 year with dilating vesicoureteral reflux at study entry but not in boys. Antibiotic prophylaxis and endoscopic treatment decreased the infection rate.
我们评估了随机分配到三种管理选择的小儿扩张性膀胱输尿管反流患者的发热性尿路感染率差异，包括抗生素预防、内镜治疗或仅作为对照的监测。
在 23 个中心，共有 203 名儿童入组研究，包括 128 名女孩和 75 名男孩，年龄为 1 岁以下。194 例发热性尿路感染（194）后，126 例发现膀胱输尿管反流 III 级，77 例发现 IV 级，9 例为产前筛查。随机分组前和 2 年后进行排尿性膀胱尿道造影和二巯基丁二酸闪烁显像。通过意向治疗原则分析发热性尿路感染率。
我们注意到 42 名女孩中有 67 例发热复发，7 名男孩中有 8 例（p = 0.0001）。在有发热感染的女孩中，预防组有 43 例中的 8 例（19%）、内镜治疗组有 43 例中的 10 例（23%）和监测组有 42 例中的 24 例（57%）复发率存在差异（p = 0.0002）。在女孩中，复发率与 2 年后持续性反流相关（p = 0.0095）。然而，研究开始时的反流严重程度（III 级或 IV 级）并不预测复发。
在这项随机对照试验中，研究开始时患有扩张性膀胱输尿管反流的 1 岁以上女孩发热性尿路感染复发率较高，但男孩没有。抗生素预防和内镜治疗降低了感染率。
