Pediatric Uro-Nephrologic Center, The Queen Silvia Children's Hospital, University of Gothenburg, SE-416 85 Göteborg, Sweden.
J Pediatr Urol. 2011 Dec;7(6):594-600. doi: 10.1016/j.jpurol.2011.05.006. Epub 2011 Jul 31.
To evaluate prophylaxis and endoscopic injection for children with dilating vesicoureteral reflux (VUR) compared to surveillance, regarding urinary tract infection (UTI) recurrence, new renal damage, VUR outcome, and impact of lower urinary tract (LUT) dysfunction on these outcomes.
203 children (128 girls and 75 boys), aged 1 to <2 years, with VUR grade III or IV were randomized to antibiotic prophylaxis (n = 69), endoscopic injection (n = 66) or surveillance (n = 68). Voiding cystourethrography, dimercaptosuccinic acid scintigraphy and optional LUT function assessment were performed before randomization and after 2 years.
There were 67 febrile UTIs in 42 girls and 8 in 7 boys (p = 0.0001). In girls, recurrence rate was 19% on prophylaxis, 23% with endoscopic treatment and 57% on surveillance (p = 0.0002). In boys, there was no difference between treatment groups. New damage was seen in 13 girls: 8 on surveillance, 5 in the endoscopic group and none on prophylaxis (p = 0.0155), and in 2 boys. In 13 children with no or non-dilating VUR after 1 injection, dilating VUR reappeared at the 2-year follow up. LUT dysfunction at follow up was associated with persistence of VUR.
In girls, prophylaxis reduced the rate of UTI recurrence and new renal damage, and endoscopic injection the rate of UTI recurrence. Boys did not benefit from active treatment.
评估与观察相比，预防性抗生素治疗和内镜下注射治疗对伴有扩张型膀胱输尿管反流（VUR）的儿童在尿路感染（UTI）复发、新的肾损伤、VUR 结局以及下尿路（LUT）功能障碍对这些结局的影响。
203 名年龄在 1 至<2 岁之间、具有 III 或 IV 级 VUR 的儿童（128 名女孩和 75 名男孩）被随机分为抗生素预防组（n=69）、内镜注射组（n=66）或观察组（n=68）。在随机分组前和 2 年后进行排尿性膀胱尿道造影、二巯丁二酸闪烁扫描和可选的 LUT 功能评估。
42 名女孩中有 67 例出现发热性 UTI，7 名男孩中有 8 例（p=0.0001）。在女孩中，预防组的复发率为 19%，内镜治疗组为 23%，观察组为 57%（p=0.0002）。在男孩中，各组之间无差异。13 名女孩出现新的损伤：观察组 8 例，内镜组 5 例，预防组无 1 例（p=0.0155），2 名男孩也出现新的损伤。在 13 名接受 1 次注射后无或非扩张性 VUR 的儿童中，扩张性 VUR 在 2 年随访时再次出现。随访时 LUT 功能障碍与 VUR 的持续存在相关。
在女孩中，预防性抗生素治疗降低了 UTI 复发和新的肾损伤的发生率，而内镜下注射治疗降低了 UTI 复发的发生率。男孩则未从积极治疗中获益。
