Department of Pediatric Urology, Women & Children's Hospital of Buffalo, Buffalo, NY 14222, USA.
J Pediatr Urol. 2013 Aug;9(4):503-8. doi: 10.1016/j.jpurol.2012.05.006. Epub 2012 Jun 17.
Controversy exists regarding the benefit of open anti-reflux surgery (OS) in reducing the incidence of urinary tract infection (UTI). We, therefore, reviewed our short and long term data in children who have undergone OS.
153 children (131F, 22M; ages 2-16 yrs, mean 8 yrs) underwent OS from 1990 to 2008. Reasons for presentation were UTI-131; sibling survey-19; prenatal hydronephrosis-3. Major reasons for OS were: breakthrough UTI-74 (48%), high grade (IV or V)-49 (32%), poor compliance with prophylaxis-15 (10%). Of 153 pre-operative DMSA scans, 60 (39%) had defects. Post-operative studies were performed 6 months after surgery and 151 (99%) had negative voiding cystourethrograms (VCUG's). All underwent urine cultures 6 months post-op and prophylaxis was stopped. 56 (37%) were later contacted at an average 7 yrs post-op (range: 2-13 yrs).
23 (15% of 153 followed short term, 40% of 56 followed long term)-20F, 3M-had non-febrile UTI's (nfUTI's) and one girl (0.6%) had a febrile UTI (fUTI). Of those who had nfUTI's 7 (30%) had high grade reflux and 16 (70%) had pre-op breakthrough UTI's. 11 (48%) had DMSA scans with defects. 2 had UTI's within 1 year after a negative VCUG and 21 had UTI's later (1-8 yrs). 1 girl had a fUTI 1 month after a negative VCUG.
Successful OS effectively eliminates fUTI. Families should be counseled that nfUTI may occur many years after surgery, especially in girls with a history of breakthrough UTI and renal scarring.
关于开放性抗反流手术（OS）降低尿路感染（UTI）发生率的益处存在争议。因此，我们回顾了在接受 OS 的儿童中的短期和长期数据。
1990 年至 2008 年期间，153 名儿童（131 名女性，22 名男性；年龄 2-16 岁，平均 8 岁）接受了 OS。就诊原因是 UTI-131；同胞调查-19；产前肾积水-3。OS 的主要原因是：突破性 UTI-74（48%），高级别（IV 或 V）-49（32%），预防措施依从性差-15（10%）。153 例术前 DMSA 扫描中，60 例（39%）有缺陷。术后 6 个月进行术后研究，151 例（99%）阴性排尿性膀胱尿道造影（VCUG）。所有患儿术后 6 个月进行尿液培养，停止预防措施。56 例（37%）在平均术后 7 年（范围：2-13 年）后进行了后续联系。
23 例（15%的短期随访，56 例中的 40%的长期随访）-20 名女性，3 名男性-患有非发热性尿路感染（nfUTI），1 名女孩（0.6%）患有发热性尿路感染（fUTI）。在患有 nfUTI 的患者中，7 例（30%）有高级别反流，16 例（70%）有术前突破性 UTI。11 例（48%）有 DMSA 扫描缺陷。2 例在阴性 VCUG 后 1 年内发生 UTI，21 例在后期发生 UTI（1-8 年）。1 名女孩在阴性 VCUG 后 1 个月发生 fUTI。
成功的 OS 可有效消除 fUTI。应告知患者，手术后多年可能会发生 nfUTI，尤其是有突破性 UTI 和肾瘢痕史的女性。
