产前肾积水评估：超声预测膀胱输尿管反流的新准则。
Evaluation of prenatal hydronephrosis: novel criteria for predicting vesicoureteral reflux on ultrasonography.
机构信息
Department of Urology, Children's National Medical Center, Washington, D. C., and Department of Anesthesia, University of Virginia Medical Center, Charlottesville, Virginia (DSG).
Department of Urology, Children's National Medical Center, Washington, D. C., and Department of Anesthesia, University of Virginia Medical Center, Charlottesville, Virginia (DSG).
出版信息
J Urol. 2014 Sep;192(3):914-8. doi: 10.1016/j.juro.2014.03.100. Epub 2014 Apr 1.
PURPOSE
Radiographic evaluation for prenatal hydronephrosis often includes voiding cystourethrography to ascertain whether vesicoureteral reflux is present. We sought to determine whether use of voiding cystourethrography could be limited to those patients at greatest risk for vesicoureteral reflux. We hypothesized that vesicoureteral reflux could be predicted by findings on renal/bladder ultrasonography of hydroureter, renal dysmorphia and/or duplication.
MATERIALS AND METHODS
We reviewed the records of patients with prenatal hydronephrosis who underwent initial postnatal ultrasonography and voiding cystourethrography during a 3-year period. The presence of vesicoureteral reflux on voiding cystourethrogram was correlated to ultrasound findings, including hydronephrosis grade, presence of hydroureter, renal dysmorphia or duplication, with ultrasound considered positive for any of the latter 3 findings.
RESULTS
Of 262 patients 47 (18%) had vesicoureteral reflux. Ultrasound was positive in 24 of 29 patients (83%) with high grade reflux and 12 of 18 (67%) with low grade reflux. If ultrasonography showed any of the 3 positive findings, the odds ratio of detecting vesicoureteral reflux was 8.07 (95% CI 3.86, 16.87). Using these criteria, among all cases of prenatal hydronephrosis 5 (2%) with high grade vesicoureteral reflux and 6 (2%) with low grade reflux would have been missed. Among the 47 cases of reflux overall 5 of 29 high grade (17%) and 6 of 18 low grade cases (33%) would have been missed.
CONCLUSIONS
By using ultrasonography criteria of hydroureter, duplication and renal dysmorphia for patients with prenatal hydronephrosis, vesicoureteral reflux can be detected more specifically. Using our criteria, 165 of 262 voiding cystourethrograms (63%) could have been avoided in patients with prenatal hydronephrosis during a 3-year period. Reducing these evaluations may decrease risks regarding radiation exposure, family anxiety and health care costs.
目的
产前肾积水的放射学评估通常包括排尿性膀胱尿道造影术，以确定是否存在膀胱输尿管反流。我们试图确定是否可以将排尿性膀胱尿道造影术仅限于那些存在膀胱输尿管反流最大风险的患者。我们假设，膀胱输尿管反流可以通过肾/膀胱超声检查中肾积水、肾畸形和/或重复肾的发现来预测。
材料与方法
我们回顾了 3 年内接受过产后初始超声检查和排尿性膀胱尿道造影术的产前肾积水患者的记录。将排尿性膀胱尿道造影术中膀胱输尿管反流的存在与超声检查结果相关联，包括肾积水程度、存在输尿管积水、肾畸形或重复肾，任何 3 种后者的发现均被认为是阳性。
结果
在 262 例患者中，有 47 例（18%）存在膀胱输尿管反流。在高分级反流的 29 例患者中，有 24 例（83%）和低分级反流的 18 例患者中有 12 例（67%）的超声检查为阳性。如果超声检查显示任何 3 种阳性发现，则检测到膀胱输尿管反流的优势比为 8.07（95%CI 3.86，16.87）。使用这些标准，在所有产前肾积水病例中，5 例（2%）高分级膀胱输尿管反流和 6 例（2%）低分级反流将会被遗漏。在总共 47 例反流病例中，29 例高分级病例中有 5 例（17%）和 18 例低分级病例中有 6 例（33%）将会被遗漏。
结论
通过使用产前肾积水患者的超声检查中输尿管积水、重复肾和肾畸形的标准，可以更具体地检测到膀胱输尿管反流。使用我们的标准，在 3 年内，262 例产前肾积水患者中有 165 例（63%）可以避免进行排尿性膀胱尿道造影术。减少这些评估可能会降低辐射暴露、家庭焦虑和医疗保健成本的风险。
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