Section of Urology, Uppsala University Children's Hospital, S-751 85 Sweden.
Ther Adv Urol. 2009 Aug;1(3):131-41. doi: 10.1177/1756287209342731.
Vesicoureteral reflux (VUR) affects around 1% of all children. It carries an increased risk of febrile urinary-tract infections (UTIs) and is associated with impaired renal function. Antibiotic prophylaxis is an established approach to managing the condition, but it does not protect against UTI and encourages bacterial resistance. Ureteral re-implantation (open surgery) is a relatively traumatic procedure typically requiring hospitalization, and there is a risk of significant post-treatment complications. Endoscopic treatment with NASHA/Dx gel (Deflux®) is minimally invasive, well tolerated and provides cure rates approaching those of open surgery: 80-90% in several studies. It has also been shown to be effective in a variety of 'complicated' cases. Thus, endoscopic treatment is generally preferable to open surgery and long-term antibiotic prophylaxis. Non-treatment of VUR is being discussed as an alternative option, although this mainly appears suitable for children with low-grade reflux and normal kidneys. A new approach to managing VUR may be considered, with treatment decisions based not only on the grade of reflux but also on factors such as age, sex, renal scarring and bladder dysfunction. Open surgery would be reserved only for use in the 10-15% of children not responding to endoscopic treatment and those with severe ureteral anomalies.
膀胱输尿管反流（VUR）影响所有儿童的 1%左右。它增加了发热性尿路感染（UTI）的风险，并与肾功能受损有关。抗生素预防是管理这种情况的既定方法，但它不能预防 UTI 并鼓励细菌耐药性。输尿管再植入（开放手术）是一种相对创伤性的手术，通常需要住院治疗，并且存在治疗后并发症的风险。NASHA/Dx 凝胶（Deflux®）的内镜治疗具有微创性，耐受性良好，并且治愈率接近开放手术：在几项研究中达到 80-90%。它也已被证明在各种“复杂”病例中有效。因此，内镜治疗通常优于开放手术和长期抗生素预防。非 VUR 治疗被讨论作为一种替代选择，尽管这主要适用于低等级反流和正常肾脏的儿童。可以考虑采用一种新的 VUR 管理方法，不仅根据反流的等级，还根据年龄、性别、肾脏瘢痕和膀胱功能障碍等因素来决定治疗决策。只有在 10-15%对内镜治疗无反应的儿童和有严重输尿管异常的儿童中，才会保留开放手术。
