Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
J Urol. 2012 Oct;188(4 Suppl):1474-9. doi: 10.1016/j.juro.2012.03.048. Epub 2012 Aug 17.
Success rates of ureteral reimplantation for primary vesicoureteral reflux are high. Few studies document the natural history of children with persistent vesicoureteral reflux. We reviewed their clinical outcomes and long-term resolution.
We performed a retrospective review of all children with persistent vesicoureteral reflux (grade 1 or greater) into the reimplanted ureter(s) on initial cystogram after reimplantation for primary vesicoureteral reflux at our institution from January 1990 to December 2002. We evaluated subsequent cystograms (graded on the 3-point radionuclide cystogram scale), surgery and urinary tract infection. We performed survival analyses of time to resolution of persistent (grade 1 or greater) and clinically significant (grade 2 or greater) vesicoureteral reflux in patients with more than 1 postoperative cystogram.
Of 965 patients 59 (94 ureters) had persistent vesicoureteral reflux (6.1%), including 19 grade 1/3, 29 grade 2/3 and 11 grade 3/3. Median patient age at reimplantation was 1.9 years (range 0.8 to 5.1) and 62.7% were female. Preoperative vesicoureteral reflux grade was 2/3 in 42.4% and 3/3 in 57.6%, and 30.5% of patients had ureteral tapering. Median followup was 47.1 months (IQR 19.3-650.3). Reflux was resolved in 26 of 36 (72.2%) patients and median time to resolution was 20.4 months. Grade 2 or greater reflux on postoperative cystogram resolved in 21 of 32 (65.6%) patients and median time to resolution was 20.4 months. There were 10 patients with persistent vesicoureteral reflux at last cystogram, grade 1 or 2 in 9 and 3/3 in 1 patient. One patient underwent repeat reimplantation for persistent vesicoureteral reflux and 7 (13%) had postoperative febrile urinary tract infection at a median of 37 months postoperatively (IQR 1.7-64.4).
Persistent vesicoureteral reflux after reimplantation resolves spontaneously in most children and can be managed nonoperatively with good long-term outcomes.
原发性输尿管反流的输尿管再植术成功率较高。很少有研究记录持续性输尿管反流患儿的自然病史。我们回顾了他们的临床结果和长期缓解情况。
我们对 1990 年 1 月至 2002 年 12 月在我院因原发性输尿管反流行输尿管再植术，术后初始膀胱造影显示输尿管再植部位存在持续性（1 级或以上）输尿管反流的所有患儿进行了回顾性研究。我们评估了后续的膀胱造影（放射性核素膀胱造影 3 级评分）、手术和尿路感染情况。对术后膀胱造影>1 次的患者，采用生存分析方法评估持续性（1 级或以上）和临床显著（2 级或以上）输尿管反流的缓解时间。
965 例患者中，59 例（94 侧输尿管）存在持续性输尿管反流（6.1%），包括 19 例 1/3 级、29 例 2/3 级和 11 例 3/3 级。输尿管再植术时患者的中位年龄为 1.9 岁（范围 0.8-5.1），62.7%为女性。术前输尿管反流程度为 2/3 级的占 42.4%，3/3 级的占 57.6%，30.5%的患者存在输尿管变细。中位随访时间为 47.1 个月（IQR 19.3-650.3）。36 例患者中有 26 例（72.2%）反流缓解，中位缓解时间为 20.4 个月。32 例术后膀胱造影中存在 2 级或以上反流的患者中有 21 例（65.6%）缓解，中位缓解时间为 20.4 个月。最后一次膀胱造影时仍有 10 例存在持续性输尿管反流，9 例为 1 级或 2 级，1 例为 3 级。1 例患者因持续性输尿管反流再次接受再植术，7 例（13%）患者术后出现发热性尿路感染，中位时间为术后 37 个月（IQR 1.7-64.4）。
大多数儿童在输尿管再植术后的持续性输尿管反流可自发缓解，可通过非手术方法进行治疗，长期效果良好。
