Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
J Pediatr Urol. 2011 Dec;7(6):632-5. doi: 10.1016/j.jpurol.2011.04.001. Epub 2011 May 12.
We report the largest known series of vesicoureteral reflux (VUR) in children with urachal anomalies (UA).
Two institutions' records were reviewed for children with UA (1951‒2007).
Of 30 girls and 36 boys with UA (34 urachal cysts, 14 patent urachus, 10 urachal diverticula, 7 urachal sinuses, and 1 unknown), 57 (86%) underwent surgical resection or drainage. A voiding cystourethrogram was obtained in 22 (33%). VUR was demonstrated in 14 of the 22 children (64%), and rates were similar among the various types of UA. The median age with versus without VUR was not different (1.3 vs 1.7 years, P=0.97). Of 24 refluxing renal units, classification was grade≤3 in 71%, 4‒5 in 12%, and unspecified in 17%. Four children (26%) underwent ureteroneocystostomy and 10 observed patients resolved spontaneously.
To our knowledge, this is the first series of VUR associated with UA. The increased incidence of VUR (64%) in this small subset of patients warrants prospective studies to determine if there is a positive correlation with UA. We believe thorough genitourinary and family histories are important when evaluating children with UA to help detect clinically significant VUR.
我们报告了已知最大系列的伴有脐尿管异常（UA）的膀胱输尿管反流（VUR）病例。
回顾了两家机构 1951 年至 2007 年间患有 UA 的儿童的记录。
30 名女孩和 36 名男孩患有 UA（34 例脐尿管囊肿、14 例开放型脐尿管、10 例脐尿管憩室、7 例脐尿管窦道和 1 例未知），其中 57 例（86%）接受了手术切除或引流。22 例（33%）患儿进行了排尿性膀胱尿道造影检查。22 例患儿中有 14 例（64%）显示 VUR，且各种类型的 UA 中 VUR 发生率相似。有 VUR 和无 VUR 的患儿中位年龄无差异（1.3 岁比 1.7 岁，P=0.97）。24 个反流性肾单位中，分级为≤3 级的占 71%，4-5 级的占 12%，未明确分级的占 17%。4 例患儿（26%）接受了输尿管膀胱再吻合术，10 例观察患儿自发缓解。
据我们所知，这是首例与 UA 相关的 VUR 系列病例。在这一小部分患者中，VUR 的发生率（64%）增加，这需要前瞻性研究来确定 UA 是否与 VUR 有正相关关系。我们认为，在评估患有 UA 的儿童时，全面的泌尿生殖系统和家族史非常重要，这有助于发现有临床意义的 VUR。
