Division of Pediatric Urology, Oregon Health and Sciences University, Portland, OR 97239, USA.
Urol Clin North Am. 2010 May;37(2):243-52. doi: 10.1016/j.ucl.2010.03.012.
There has been an emergence of a therapeutic nihilistic attitude about the surgical treatment of vesicoureteral reflux (VUR). Evidence-based reviews have questioned whether surgical treatment is beneficial for children with VUR. Even the use of prophylactic antibiotics, which have traditionally been the first-line therapy recommended for virtually all patients with VUR, has come under scrutiny after several randomized controlled trials found them to have no effect on decreasing the risk of urinary tract infections (UTIs) in children with VUR. Grade is the strongest predictor of VUR resolution, with high-grade VUR being much less likely to resolve. Other factors that negatively influence resolution include lower bladder volume or pressure at onset of reflux, older age, female sex, bilateral VUR, ureteral duplication, abnormal or scarred kidneys, and bladder dysfunction. These factors can be used, along with grade, in computer models or nomograms to improve the ability to predict spontaneous resolution.
人们对治疗性膀胱输尿管反流（VUR）的手术治疗出现了一种虚无主义态度。循证审查质疑手术治疗对 VUR 患儿是否有益。即使是预防性抗生素的使用，它一直是推荐给几乎所有 VUR 患者的一线治疗方法，在几项随机对照试验发现它们对降低 VUR 患儿尿路感染（UTI）的风险没有影响后，也受到了质疑。分级是 VUR 缓解的最强预测因素，高级别 VUR 缓解的可能性要小得多。其他影响缓解的负面因素包括反流起始时膀胱容量或压力较低、年龄较大、女性、双侧 VUR、输尿管重复、肾脏异常或有疤痕、膀胱功能障碍。这些因素可以与分级一起，用于计算机模型或列线图中，以提高预测自发缓解的能力。
