Department of Pediatric Urology, Sri Ramachandra University, Chennai, Tamil Nadu, India.
Department of Pediatric Urology, Indraprastha Apollo Hospitals, New Delhi, 110076, India.
Indian J Pediatr. 2017 Jul;84(7):540-544. doi: 10.1007/s12098-017-2359-4. Epub 2017 May 6.
The primary goal in the management of a child with urinary tract infection (UTI) is to prevent recurrence of UTI and acquired renal damage. Approximately 15% of children develop renal scarring after a first episode of febrile UTI. Vesico-ureteric reflux (VUR) is diagnosed in 30-40% of children imaged after first febrile UTI. The 'top-down' approach involving ultrasound and dimercaptosuccinic acid scan (DMSA) first after an appropriate interval following UTI, can help in avoiding voiding cystourethrogram (VCUG), an invasive test with higher radiation exposure. The majority view remains that VCUG should be done after the second attack of UTI in girls and first attack of UTI in boys. Although the evidence in favour of antibiotic prophylaxis remains doubtful in preventing renal scars associated with VUR, it remains the first line treatment for high-grade reflux (grade 3-5) with an aim to prevent UTI and allow spontaneous resolution of VUR. Early identification and appropriate treatment of associated bowel bladder dysfunction is an essential part of successful medical management of VUR. Endoscopic treatment of VUR, using a bulking agent, is useful in grade 3 VUR. The main controversy regarding intervention (endoscopic/open surgical intervention) involves absence of strong evidence for these interventions in reducing renal scarring on randomized controlled trials. However, several recent trials have found the surgical interventions to be effective in reducing recurrent pyelonephritis and repeated hospital admissions.
儿童尿路感染（UTI）管理的主要目标是预防 UTI 复发和获得性肾损伤。约 15%的儿童在首次发热性 UTI 后出现肾瘢痕形成。在首次发热性 UTI 后适当间隔进行超声和二巯丁二酸扫描（DMSA）成像后，约 30-40%的儿童被诊断为膀胱输尿管反流（VUR）。这种“自下而上”的方法有助于避免膀胱尿道造影（VCUG），后者是一种具有更高辐射暴露的侵入性检查。大多数观点仍然认为，在女孩第二次 UTI 发作和男孩首次 UTI 发作后应进行 VCUG。尽管抗生素预防在预防与 VUR 相关的肾瘢痕方面的证据仍然存在疑问，但它仍然是治疗高级别反流（3-5 级）的一线治疗方法，目的是预防 UTI 并允许 VUR 自发消退。早期识别和适当治疗相关的肠道膀胱功能障碍是成功治疗 VUR 的重要组成部分。使用填充剂的 VUR 内镜治疗对 3 级 VUR 有用。干预（内镜/开放手术干预）的主要争议在于随机对照试验中缺乏这些干预措施在减少肾瘢痕形成方面的强有力证据。然而，几项最近的试验发现，手术干预在减少复发性肾盂肾炎和反复住院方面是有效的。
