Donovan J M, Ney K G, Maizels M
Division of Urology, Children's Memorial Hospital, Chicago, Illinois.
Urol Clin North Am. 1989 Nov;16(4):841-55.
Ultrasound has proved to be very accurate in evaluating children with common urologic problems such as renal obstruction and urinary infection and in screening for uropathology among children with siblings known to have urologic disease. The benefits of ultrasound in a pediatric population include diagnostic accuracy, ease of use, absence of radiation exposure, and no risk of adverse reactions to contrast agents. As a consequence, ultrasound has become routine in the evaluation of children with urologic conditions, and its use has been expanded to screening of healthy infants for urinary tract abnormalities. One (1.3 per cent) of 73 otherwise-healthy babies studied had urologic problems severe enough to warrant surgery. Steinhart and associates recommended the routine use of ultrasound in healthy infants, because a significant number of infants harbor silent urinary tract abnormalities that can be detected by ultrasound at a low cost. Obstetricians and other primary-care physicians as well as urologists have incorporated the office use of ultrasound into the care for their patients and thus avoid the inconvenience and difficulties of outside referral. In addition, the clinician as a sonographer occupies a unique position that permits sonographic information to be related directly to the clinical problem. In this review, we have included more than three times the number of patients studied in the initial report. The ease and accuracy of office ultrasound that we described initially have been confirmed by subsequent experience. The urosound examination is indicated for the initial evaluation of patients with voiding symptoms, urine infection, or hematuria, as well as to screen patients with known congenital anomalies, such as hypospadias. Urosound can be employed in the surveillance of children with dysfunctional voiding to measure the completeness of bladder emptying and hydronephrosis. The degree of hydronephrosis in cases of ureteropelvic junction obstruction, megaureters, ectopic ureters, and ureteroceles and that remaining after surgery may be documented by urosound examination. We have found that when the urosound study is abnormal, further diagnostic evaluation is more efficiently planned. Office-based pediatric urologist-operated ultrasound supplements the information elicited from routine history, physical examination, laboratory studies, and other radiologic investigations.
超声已被证明在评估患有常见泌尿系统问题（如肾梗阻和尿路感染）的儿童以及在筛查有患泌尿系统疾病兄弟姐妹的儿童的泌尿系统病变方面非常准确。超声在儿科人群中的优势包括诊断准确性、使用便捷、无辐射暴露以及无造影剂不良反应风险。因此，超声已成为评估泌尿系统疾病儿童的常规检查，其应用范围已扩大到对健康婴儿进行泌尿道异常筛查。在研究的73名其他方面健康的婴儿中，有1名（1.3%）存在严重到需要手术治疗的泌尿系统问题。斯坦哈特及其同事建议对健康婴儿常规使用超声，因为大量婴儿存在无症状的泌尿系统异常，超声能够以低成本检测到这些异常。产科医生和其他初级保健医生以及泌尿科医生已将门诊超声检查纳入对患者的护理中，从而避免了外部转诊的不便和困难。此外，临床医生作为超声检查者处于独特地位，能够使超声检查信息直接与临床问题相关联。在本综述中，我们纳入的患者数量是初始报告中研究患者数量的三倍多。我们最初描述的门诊超声检查的便捷性和准确性已得到后续经验的证实。超声检查适用于对有排尿症状、尿路感染或血尿的患者进行初步评估，以及对已知先天性异常（如尿道下裂）的患者进行筛查。超声可用于监测排尿功能障碍儿童，以测量膀胱排空的完整性和肾积水情况。超声检查可记录输尿管肾盂连接部梗阻、巨输尿管、异位输尿管和输尿管囊肿病例中的肾积水程度以及手术后残留的肾积水程度。我们发现，当超声检查结果异常时，能更有效地规划进一步的诊断评估。基于门诊的儿科泌尿科医生操作超声检查可补充从常规病史、体格检查、实验室检查和其他放射学检查中获取的信息。
