Department of Urology and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
J Urol. 2016 Apr;195(4 Pt 2):1294-9. doi: 10.1016/j.juro.2015.03.094. Epub 2015 Mar 23.
The vesicoureteral reflux index is a novel tool designed to predict spontaneous reflux resolution in infants younger than 2 years. We performed a multi-institutional validation study to confirm the discriminatory power of the vesicoureteral reflux index to predict the vesicoureteral reflux resolution rate in young children.
We identified patients diagnosed with primary vesicoureteral reflux before age 24 months who had 2 or more voiding cystourethrograms available. Demographics, vesicoureteral reflux grade and timing, ureteral anomalies and radiographic outcomes were evaluated. The C-index was estimated for time to event model assessment.
A total of 219 girls and 150 boys met study inclusion criteria. Mean ± SD age at diagnosis was 4.7 ± 4.9 months. Of the patients 101 (27.4%) had early to mid filling, 214 (58%) had late filling and 54 (14.6%) had voiding only vesicoureteral reflux. High grade reflux was present in 87 patients (23.6%) and ureteral anomalies were observed in 50 (13.6%). A vesicoureteral reflux index of 1, 2, 3, 4 and 5 or greater showed an improvement/resolution rate of 88.2%, 77.3%, 62.3%, 32.1% and 14.3%, respectively. On time to event analysis children with filling phase vesicoureteral reflux (p <0.001), grade 4-5 reflux (p <0.001) and ureteral anomalies (p = 0.003) had significantly longer median time to resolution. Median time to spontaneous resolution was 12.6, 12.7, 15.1, 25.6 and 31 months or greater for a vesicoureteral reflux index of 1, 2, 3, 4 and 5 or greater, respectively (C-index 0.305, 95% CI 0.252-0.357). During the study period 65 patients (17.6%) underwent surgical intervention.
The vesicoureteral reflux index is a simple tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in patients diagnosed at younger than 2 years. The index provides valuable prognostic information, facilitating individualized patient care.
膀胱输尿管反流指数是一种新的工具，旨在预测 2 岁以下婴儿自发性反流消退。我们进行了一项多机构验证研究，以确认膀胱输尿管反流指数预测幼儿膀胱输尿管反流消退率的区分能力。
我们确定了 24 个月前被诊断为原发性膀胱输尿管反流的患者，这些患者有 2 次或更多次排尿性膀胱尿道造影术可供评估。评估了人口统计学资料、膀胱输尿管反流分级和时间、输尿管异常和影像学结果。使用时间事件模型评估估计 C 指数。
共有 219 名女孩和 150 名男孩符合研究纳入标准。诊断时的平均年龄 ± 标准差为 4.7 ± 4.9 个月。101 例（27.4%）患者为早期至中期充盈，214 例（58%）为晚期充盈，54 例（14.6%）仅为排尿性膀胱输尿管反流。87 例（23.6%）存在高级别反流，50 例（13.6%）存在输尿管异常。膀胱输尿管反流指数为 1、2、3、4 和 5 或更高时，改善/消退率分别为 88.2%、77.3%、62.3%、32.1%和 14.3%。在时间事件分析中，充盈期膀胱输尿管反流的儿童（p <0.001）、4-5 级反流（p <0.001）和输尿管异常（p = 0.003）的中位缓解时间明显延长。膀胱输尿管反流指数为 1、2、3、4 和 5 或更高时，自发性缓解的中位时间分别为 12.6、12.7、15.1、25.6 和 31 个月或更长时间（C 指数 0.305，95%CI 0.252-0.357）。在研究期间，65 例患者（17.6%）接受了手术干预。
膀胱输尿管反流指数是一种简单的工具，可可靠地预测 2 岁以下患者原发性反流的显著改善和自发性消退。该指数提供了有价值的预后信息，有助于个体化的患者护理。
