Yel Sibel, Tülpar Sebahat, Düşünsel Ruhan, Poyrazoğlu Hakan Muammer, Dursun İsmail, Abdülrezzak Ümmühan, Gündüz Zübeyde, Yılmaz Kenan, Baştuğ Funda
Department of Pediatric Nephrology, Erciyes University School of Medicine, Kayseri, Turkey.
Department of Nuclear Medicine, Erciyes University School of Medicine Kayseri, Turkey.
Turk J Urol. 2017 Mar;43(1):79-84. doi: 10.5152/tud.2016.56750. Epub 2017 Jan 27.
In this study, we examined the patients' characteristics, who underwent voiding cystourethrography (VCUG), in order to determine any selectivity for indication of this invasive method.
After exclusion of indications of neurogenic bladder or antenatal hydronephrosis and control VCUGs, 159 VCUGs performed in our clinic within one year were evaluated. Patients are divided into three groups accoding to age. Clinical characteristic and findings of renal ultrasonography (US) and renal scintigraphy were examined.
Vesicoureteral reflux (VUR) was detected in 61 (38.3%) of 159 patients who underwent cystourethrographic examinations, in 45.8% of the patients with a history of recurrent urinary tract infection (UTI), in 22.0% of the patients with pathological urinary system US without history of recurrent UTI. High-grade reflux rate was significantly more frequent in renal units with pathological US findings. Severe scar was significantly more frequent in renal units with high-grade reflux when compared to renal units without reflux and those with low-grade reflux. Predictive values of recurrent UTI, scarring status and pathological US for VUR were separately analyzed and seen that likelihood of indicating VUR was increased when all 3 risk factors were assessed together.
Vesicoureteral reflux is a problem in which diagnostic process and management strategy should have to be considered in individualized manner for each patient. Before prescribing invasive VCUG, imaging urinary system by US and scintigraphy and determining whether there is recurrent UTI will improve selectivity and success of VCUG.
在本研究中，我们检查了接受排尿性膀胱尿道造影（VCUG）的患者的特征，以确定这种侵入性检查方法的适应证是否具有选择性。
在排除神经源性膀胱或产前肾积水的适应证及对照性VCUG后，对我们诊所1年内进行的159例VCUG进行了评估。根据年龄将患者分为三组。检查了临床特征以及肾脏超声（US）和肾脏闪烁扫描的结果。
在159例接受膀胱尿道造影检查的患者中，61例（38.3%）检测到膀胱输尿管反流（VUR），有复发性尿路感染（UTI）病史的患者中45.8%检测到VUR，泌尿系统超声检查有病理改变但无复发性UTI病史的患者中22.0%检测到VUR。在超声检查有病理改变的肾单位中，高级别反流的发生率明显更高。与无反流和低级别反流的肾单位相比，高级别反流的肾单位中严重瘢痕的发生率明显更高。分别分析了复发性UTI、瘢痕形成状态和超声检查病理改变对VUR的预测价值，发现当同时评估所有3个危险因素时，提示VUR的可能性增加。
膀胱输尿管反流是一个诊断过程和管理策略应针对每个患者进行个体化考虑的问题。在进行侵入性VCUG之前，通过超声和闪烁扫描对泌尿系统进行成像并确定是否存在复发性UTI，将提高VCUG的选择性和成功率。
