McLorie G A, McKenna P H, Jumper B M, Churchill B M, Gilmour R F, Khoury A E
Hospital for Sick Children, Toronto, Ontario, Canada.
J Urol. 1990 Aug;144(2 Pt 2):537-40; discussion 545. doi: 10.1016/s0022-5347(17)39516-2.
Between 1981 and 1987, 300 patients with high grade (III, IV and V international classification) vesicoureteral reflux were treated at a single pediatric hospital. Only patients with primary vesicoureteral reflux were included in the study. The guiding principle during this period was that all patients with high grade vesicoureteral reflux would be observed on prophylactic antibiotics (observational therapy) and surgical correction would be reserved for specific indications. Of the 300 patients 132 received observational therapy alone and 168 required surgical correction for specific indications after varying periods of observation. In both groups the duration of persistent reflux was analyzed using a life-table method. In patients with grade V reflux we observed resolution in 3 patients whereas 23 required surgical correction. Of those patients in the observation group with grade IV reflux 83% had persistent reflux at 2 years and 70% still had reflux at 5 years. For those with grade III reflux the persistence rate was 83% and 50%, respectively. Neither age, sex nor side of reflux had a correlation with the rate of resolution. When tested grade of reflux correlated loosely (p = 0.07). During the period of observational therapy new renal scars developed in 23 patients (8%). We conclude that high grade vesicoureteral reflux can resolve in a minority of patients over a protracted interval. On the basis of this analysis, we advocate consideration of surgical correction in these patients after a 4-year period of observational therapy and for specific indications.
1981年至1987年间，一家儿科医院对300例患有高级别（国际分类III、IV和V级）膀胱输尿管反流的患者进行了治疗。该研究仅纳入原发性膀胱输尿管反流患者。在此期间的指导原则是，所有高级别膀胱输尿管反流患者都将接受预防性抗生素观察治疗（观察性治疗），手术矫正仅用于特定指征。300例患者中，132例仅接受观察性治疗，168例在经过不同时间段的观察后因特定指征需要进行手术矫正。两组均采用寿命表法分析持续性反流的持续时间。在V级反流患者中，我们观察到3例反流消失，而23例需要手术矫正。在观察组IV级反流患者中，83%在2年时仍有持续性反流，70%在5年时仍有反流。III级反流患者的持续率分别为83%和50%。年龄、性别和反流侧与反流消失率均无相关性。经检验，反流级别相关性较弱（p = 0.07）。在观察性治疗期间，23例患者（8%）出现了新的肾瘢痕。我们得出结论，少数高级别膀胱输尿管反流患者可在较长时间内反流消失。基于此分析，我们主张在观察性治疗4年后，针对特定指征，考虑对这些患者进行手术矫正。
