University of Alabama at Birmingham, USA.
J Urol. 2010 Oct;184(4 Suppl):1594-7. doi: 10.1016/j.juro.2010.04.020. Epub 2010 Aug 21.
Treatment for vesicoureteral reflux remains controversial. Lacking an evidence-based treatment protocol, we offered the option of terminating prophylactic antibiotics in otherwise healthy patients with persistent vesicoureteral reflux at age 5 years or greater. We report outcomes with respect to the urinary tract infection incidence and to whether surgical intervention was eventually done.
We obtained institutional review board approval to retrospectively review the records of all children with vesicoureteral reflux from December 1999 to February 2009. Of this group we selected children 5 years old or older who had been taken off prophylactic antibiotics. We assessed children with primary vesicoureteral reflux in detail.
The records of 1,217 that we reviewed showed that antibiotics were discontinued in 185 patients, including 160 girls (89%) and 25 boys (11%), at an average age of 6.2 years. Average followup was 2.0 years with recorded followup up to 8 years off prophylaxis. In 50 girls (91%) and 5 boys (9%), urinary tract infection developed after discontinuing prophylaxis. Correction was done in 57 patients, including open repair in 34 and endoscopic injection in 23. Two patients underwent intervention at parent request after an average of 0.7 years of uneventful observation. We identified no parameter predicting patients at risk for urinary tract infection.
Urinary tract infection develops in 29% of patients 5 years old or older with persistent vesicoureteral reflux within 2 years after the cessation of prophylaxis. Most of these cases are febrile. Discontinuing antibiotics is reasonable but a prospective, randomized, long-term, multi-institutional trial is required to determine whether this approach is beneficial.
治疗膀胱输尿管反流仍然存在争议。由于缺乏循证治疗方案，我们为年龄在 5 岁及以上、持续性膀胱输尿管反流且无其他健康问题的患者提供了停用预防性抗生素的选择。我们报告了尿路感染发生率以及最终是否进行手术干预的结果。
我们获得机构审查委员会的批准，回顾性地审查了 1999 年 12 月至 2009 年 2 月期间所有患有膀胱输尿管反流的儿童的记录。在这个组中，我们选择了 5 岁或以上停用预防性抗生素的儿童。我们详细评估了原发性膀胱输尿管反流的儿童。
我们回顾的 1217 份记录显示，185 名患者（包括 160 名女孩[89%]和 25 名男孩[11%]）停用了抗生素，平均年龄为 6.2 岁。平均随访时间为 2.0 年，随访记录最长可达停用预防措施 8 年。在 50 名女孩（91%）和 5 名男孩（9%）中，停用预防措施后发生了尿路感染。在 57 名患者中进行了矫正，包括 34 名开放性修复和 23 名内镜注射。两名患者在平均无并发症观察 0.7 年后，根据家长要求进行了干预。我们没有发现可预测患者尿路感染风险的参数。
在停止预防措施后 2 年内，5 岁及以上持续性膀胱输尿管反流的患者中有 29%会发生尿路感染。大多数情况下这些病例都是发热性的。停用抗生素是合理的，但需要进行前瞻性、随机、长期、多机构试验，以确定这种方法是否有益。
