Rudzinski Jan K, Weber Bryce, Wildgoose Petra, Lorenzo Armando, Bagli Darius, Farhat Walid, Harvey Elizabeth, Salle Joao Luiz Pippi
Department of Pediatric Urology, The Hospital for Sick Children, Calgary, AB.
Can Urol Assoc J. 2013 Jul-Aug;7(7-8):E467-9. doi: 10.5489/cuaj.202.
Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR.
We prospectively analyzed children with a previous diagnosis of VUR seen in the outpatient clinic with a routine follow-up RUS within 4 months. Variables collected included: demographic data, VUR history, dysfunctional voiding symptoms and concurrent ultrasound findings. Change in management was defined as addition of new medication, nurse counselling, surgery or further investigations.
The study included 114 consecutive patients. The mean patient age was 4.5 years old, mean age of VUR diagnosis was 1.7 years, with average follow-up of 2.8 years. A change in management with stable RUS occurred in 14 patients, in which the change included ordering a DMSA in 9, nurse counselling for dysfunctional voiding in 3, and booking surgery in 2 patients. Change on RUS was seen in 4 patients. Multivariable analysis showed that history of urinary tract infection (UTI) since the last follow-up visit was more significant than RUS findings.
The RUS findings in most patients followed for VUR remain stable or with minimal changes. The variable showing a significant effect on change in management in our study was history of UTI since the last follow-up visit rather than RUS findings. The value of follow-up RUS for children with VUR may need to be revisited.
患有膀胱输尿管反流（VUR）的儿童通常需要进行肾脏超声检查（RUS）。关于VUR随访RUS的作用的数据很少。我们评估了随访RUS对VUR患者临床管理变化的影响。
我们前瞻性分析了门诊中先前诊断为VUR的儿童，在4个月内进行常规随访RUS。收集的变量包括：人口统计学数据、VUR病史、排尿功能障碍症状和同时出现的超声检查结果。管理变化定义为添加新药物、护士咨询、手术或进一步检查。
该研究包括114例连续患者。患者平均年龄为4.5岁，VUR诊断的平均年龄为1.7岁，平均随访2.8年。14例患者在RUS稳定的情况下管理发生了变化，其中变化包括9例患者进行二巯基丁二酸（DMSA）检查、3例患者因排尿功能障碍接受护士咨询以及2例患者安排手术。4例患者RUS出现变化。多变量分析显示，自上次随访以来的尿路感染（UTI）病史比RUS检查结果更具显著性。
大多数接受VUR随访的患者的RUS检查结果保持稳定或变化极小。在我们的研究中，对管理变化显示出显著影响的变量是自上次随访以来的UTI病史，而非RUS检查结果。VUR患儿随访RUS的价值可能需要重新审视。
