Department of Paediatrics, University Hospital, Oulu, Finland.
Acta Paediatr. 2010 Dec;99(12):1875-8. doi: 10.1111/j.1651-2227.2010.01909.x.
The reported low occurrence of vesicoureteral reflux in the general population seems implausible. We wanted to test the hypothesis that reflux is more common and more independent of urinary-tract infection than has previously been thought.
We tested our hypothesis by analysing the characteristics of 406 consecutive children aged <5years who had been referred for consultation because of urinary-tract infection. Using data on their urine samples, we evaluated the reliability of the urinary-tract infection diagnosis and analysed the frequencies of vesicoureteral reflux and abnormal ultrasound findings in three reliability groups (A: certain urinary-tract infection, B: possible and C: improbable).
The occurrence of reflux was the same irrespective of the diagnostic reliability of urinary-tract infection (A: 98/276 [36%] versus B: 13/46 [28%] versus C: 9/25 [36%]). Most of the abnormal ultrasound findings (58/71, 80%) were found among patients with a certain diagnosis (Group A).
We suggest that vesicoureteral reflux is more common in children even without urinary-tract infection than has been thought previously. The guidelines recommending a search for reflux by means of voiding cystourethrography should be reconsidered.
人群中报道的膀胱输尿管反流发生率较低似乎不太可信。我们希望通过研究来验证这样一个假设，即反流比之前认为的更为常见，且与尿路感染的相关性更小。
我们通过分析 406 例因尿路感染就诊的＜5 岁连续儿童的特征来验证我们的假设。通过对尿液样本的数据评估，我们评估了尿路感染诊断的可靠性，并在三个可靠性组（A：明确的尿路感染、B：可能的尿路感染和 C：不太可能的尿路感染）中分析了膀胱输尿管反流和异常超声结果的发生频率。
反流的发生与尿路感染的诊断可靠性无关（A：276 例中有 98 例[36%]，B：46 例中有 13 例[28%]，C：25 例中有 9 例[36%]）。大多数异常超声发现（58/71，80%）见于诊断明确的患者（A 组）。
我们认为，即使在没有尿路感染的情况下，儿童的膀胱输尿管反流也比之前认为的更为常见。建议重新考虑通过排尿性膀胱尿道造影来寻找反流的指南。
