Jellouli Manel, Ben Mansour Asma, Abidi Kamel, Ferjani Meriem, Naija Ouns, Hammi Yousra, Zarrouk Chokri, Gargah Tahar
Tunis Med. 2016 Jun;94(6):167-170.
Background - Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (US) and voiding cystourethrography (VCUG). We propose to determine whether abnormalities found on US can help indicate the necessity of VCUG in children after the first urinary tract infection. Methods - A retrospective study included all children admitted with their first episode of urinary tract infection from January 2007 to December 2012. Results - A total of 311 children were included. The median age was 2.5 years, 72.3% were female. VUR Prevalence was 14%. Forty-four patients were found to have VUR on VCUG, giving a prevalence of 14%. Of these 44 patients, 11 had grade I reflux, 6 had grade II reflux, 3 had grade III reflux, 15had grade IV reflux, and 9 had grade V reflux. Ultrasound findings were positive for VUR in 43 patients, 19 of them had RVU. Twenty five patients had a normal ultrasound but showed VUR on VCUG (11 had grade I reflux, six grade II reflux, three grade III reflux and five grade IV reflux). The sensitivity and specificity of ultrasound in suggesting VUR were 43% and 91%, respectively. The positive predictive value of ultrasound in suggesting VUR was 44%; the negative predictive value was 91%. Conclusion - Renal ultrasound findings are specific for VUR in children with a first UTI, but no sensitive. Clinicians should consider renal ultrasound results to take decision on whether or not to proceed with a VCUG in the investigation of a first episode UTI in young children.
背景 - 膀胱输尿管反流（VUR）是一种常见的儿科泌尿系统疾病。首次尿路感染（UTI）后，建议进行影像学检查，首先是肾脏超声（US）和排尿性膀胱尿道造影（VCUG）。我们旨在确定US检查发现的异常是否有助于指示首次尿路感染后儿童进行VCUG检查的必要性。方法 - 一项回顾性研究纳入了2007年1月至2012年12月因首次尿路感染入院的所有儿童。结果 - 共纳入311名儿童。中位年龄为2.5岁，72.3%为女性。VUR患病率为14%。44例患者在VCUG检查中发现有VUR，患病率为14%。在这44例患者中，11例为I级反流，6例为II级反流，3例为III级反流，15例为IV级反流，9例为V级反流。43例患者的超声检查结果显示VUR阳性，其中19例有肾瘢痕。25例患者超声检查正常，但在VCUG检查中显示有VUR（11例为I级反流，6例为II级反流，3例为III级反流，5例为IV级反流）。超声检查提示VUR的敏感性和特异性分别为43%和91%。超声检查提示VUR的阳性预测值为44%；阴性预测值为91%。结论 - 肾脏超声检查结果对首次UTI患儿的VUR具有特异性，但不具有敏感性。临床医生在决定是否对幼儿首次UTI进行VCUG检查时应考虑肾脏超声检查结果。
