Hunziker Manuela, Kutasy Balazs, D'Asta Federica, Puri Prem
National Children's Research Centre, Our Lady's Children's Hospital, Dublin-12, Ireland.
Pediatr Surg Int. 2012 Feb;28(2):201-4. doi: 10.1007/s00383-011-2986-1.
Few studies have evaluated the significance of associated urological anomalies in vesicoureteral reflux (VUR). The aim of our study was to determine the incidence of associated urological anomalies in patients with high grade VUR and to assess their impact on renal parenchymal scarring.
We retrospectively reviewed the hospital records of 1,765 consecutive cases diagnosed with high grade VUR (Grade III-V) at our hospital between 1998 and 2010. The diagnosis of VUR was made by a voiding cystourethrogram (VCUG). Renal scarring was evaluated by dimercapto-succinic acid (DMSA) scintigraphy and classified into three groups: mild (focal defects in uptake between 40 and 45%), moderate (uptake of renal radionuclide between 20 and 40%), and severe (shrunken kidney with relative uptake <20%). All associated urological anomalies were diagnosed by ultrasound or VCUG or DMSA scan.
Associated urological anomalies were present in 229 (13%) children. There were 87 boys and 142 girls. Duplex kidney was the main associated anomaly occurring in 148 (64.6%) of the 229 patients. Other anomalies were: bladder diverticulum in 29, solitary kidney in 12, ureterocele in 13, hypospadiasis in 11, pelviureteric junction obstruction in 9, malrotated kidney in 3, horseshoe kidney in 2, crossed fused ectopia in 1 and renal cyst in 1. DMSA scan revealed renal scarring in 105 (47.7%) of the 220 children who had a DMSA scan. 75 (50.7%) children with duplex kidneys showed renal scarring.
Associated urological anomalies occur commonly in patients with high grade VUR. Our data shows that nearly half of the patients with VUR and associated urological anomalies have renal scarring. Early recognition and treatment of VUR patients with associated urological anomalies may decrease the risk of renal parenchymal damage.
很少有研究评估膀胱输尿管反流（VUR）中相关泌尿系统异常的意义。我们研究的目的是确定重度VUR患者中相关泌尿系统异常的发生率，并评估其对肾实质瘢痕形成的影响。
我们回顾性分析了1998年至2010年间在我院连续诊断为重度VUR（III - V级）的1765例患者的医院记录。VUR的诊断通过排尿性膀胱尿道造影（VCUG）进行。肾瘢痕形成通过二巯基丁二酸（DMSA）闪烁扫描评估，并分为三组：轻度（摄取局部缺损在40%至45%之间）、中度（肾放射性核素摄取在20%至40%之间）和重度（肾脏萎缩，相对摄取<20%）。所有相关泌尿系统异常均通过超声、VCUG或DMSA扫描诊断。
229名（13%）儿童存在相关泌尿系统异常。其中男孩87名，女孩142名。重复肾是主要的相关异常，在229例患者中的148例（64.6%）出现。其他异常包括：膀胱憩室29例、孤立肾12例、输尿管囊肿13例、尿道下裂11例、肾盂输尿管连接处梗阻9例、旋转不良肾3例、马蹄肾2例、交叉融合异位肾1例和肾囊肿1例。DMSA扫描显示，在进行DMSA扫描的220名儿童中，105名（47.7%）有肾瘢痕形成。75名（50.7%）重复肾儿童出现肾瘢痕形成。
相关泌尿系统异常在重度VUR患者中常见。我们的数据表明，近一半患有VUR及相关泌尿系统异常的患者有肾瘢痕形成。早期识别和治疗伴有相关泌尿系统异常的VUR患者可能会降低肾实质损害的风险。
