Division of Urology, McGill University Health Center, Montreal, Quebec, Canada.
J Pediatr Urol. 2011 Dec;7(6):601-10. doi: 10.1016/j.jpurol.2011.06.002. Epub 2011 Jul 7.
No method exists for predicting which child with vesicoureteral reflux (VUR) will have surgery. Our goals were to analyze practice patterns at a major pediatric center and to identify factors predisposing children to surgery for specific indications.
We analyzed a cohort of 3738 children presenting with primary VUR (1996-2005). Surgical indications included: 1) breakthrough urinary tract infection (UTI), 2) non-resolution over 3 years, 3) renal scan abnormality and 4) parent/surgeon preference. Logistic regression was applied to a random 60% subset of children. Validation in the remaining 40% was done using receiver operating characteristic curve analysis and the Hosmer and Lemeshow goodness-of-fit test.
Independent predictors of surgery included higher age at presentation, antenatal hydronephrosis (ANH), bilateral VUR and VUR grade. Predictors of surgery for a breakthrough UTI included female gender, increasing age, and bilateral and high-grade VUR. Girls were less likely than boys to be operated for renal scan abnormality or parent/surgeon preference. ANH was a predictor of surgery for decreased function and parent/surgeon preference. The model had fair discrimination (c-statistic = 0.68-0.76) and high calibration (p ≥ 0.24). Probabilities of surgery were calculated.
Higher age at presentation, being followed for ANH, and bilateral and high-grade VUR are independent predictors of VUR-corrective surgery. Predictors of surgery vary with indication. Our methods allow comparison of urological practice patterns and outcomes between institutions by taking into account indications for surgery.
目前尚无方法预测哪些患有膀胱输尿管反流（VUR）的儿童需要手术。我们的目的是分析一个主要儿科中心的实践模式，并确定导致儿童接受特定适应证手术的相关因素。
我们分析了一组 3738 例初发 VUR 患儿（1996-2005 年）的资料。手术适应证包括：1）复发性尿路感染（UTI），2）3 年内未缓解，3）肾扫描异常，4）患儿及外科医生的偏好。将 60%的患儿数据随机应用逻辑回归，对剩余 40%的患儿采用受试者工作特征曲线分析和 Hosmer-Lemeshow 拟合优度检验进行验证。
独立的手术预测因素包括就诊时年龄较大、产前肾积水（ANH）、双侧 VUR 和 VUR 分级。复发性 UTI 手术的预测因素包括女性、年龄增长、双侧和高级别 VUR。与男孩相比，女孩接受肾扫描异常或患儿及外科医生偏好手术的可能性较低。ANH 是肾功能下降和患儿及外科医生偏好手术的预测因素。该模型具有良好的区分度（C 统计量为 0.68-0.76）和高度的校准度（p≥0.24）。计算了手术概率。
就诊年龄较大、随访 ANH 以及双侧和高级别 VUR 是 VUR 矫正手术的独立预测因素。手术适应证不同，预测因素也不同。我们的方法通过考虑手术适应证，能够比较不同机构的泌尿外科实践模式和结果。
