Division of Urologic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Eur Urol. 2012 Apr;61(4):773-82. doi: 10.1016/j.eururo.2012.01.002. Epub 2012 Jan 11.
Vesicoureteral reflux (VUR) is present in approximately 1% of children in North America and Europe and is associated with an increased risk of pyelonephritis and renal scarring. Despite its prevalence and potential morbidity, however, many aspects of VUR management are controversial.
Review the evidence surrounding current controversies in VUR diagnosis, screening, and treatment.
A systematic review was performed of Medline, Embase, Prospero, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, clinicaltrials.gov, and the most recent guidelines of relevant medical specialty organizations.
We objectively assessed and summarized the published data, focusing on recent areas of controversy relating to VUR screening, diagnosis, and treatment.
The evidence base for many current management patterns in VUR is limited. Areas that could significantly benefit from additional future research include improved identification of children who are at risk for VUR-related renal morbidity, improved stratification tools for determining which children would benefit most from which VUR treatment option, and improved reporting of long-term outcomes of VUR treatments.
在北美和欧洲，大约有 1%的儿童存在膀胱输尿管反流（VUR），与肾盂肾炎和肾瘢痕形成的风险增加有关。然而，尽管 VUR 很常见且可能导致发病，但其诊断、筛查和治疗方面仍存在许多争议。
综述 VUR 诊断、筛查和治疗方面当前争议的相关证据。
对 Medline、Embase、Prospéro、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库、clinicaltrials.gov 以及相关医学专业组织的最新指南进行了系统评价。
我们客观评估并总结了已发表的数据，重点关注与 VUR 筛查、诊断和治疗相关的最新争议领域。
目前 VUR 许多管理模式的证据基础有限。在以下方面，未来的研究可能会带来显著的益处：更好地识别有发生 VUR 相关肾脏发病风险的儿童；更好地确定哪些儿童最能从哪种 VUR 治疗方案中获益的分层工具；以及更好地报告 VUR 治疗的长期结局。
