Hettel Daniel R, Gill Bradley C, Rhee Audrey C
Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Adv Urol. 2017;2017:3197869. doi: 10.1155/2017/3197869. Epub 2017 Apr 11.
. To determine if routine preoperative and intraoperative urine cultures (UCx) are necessary in pediatric vesicoureteral (VUR) reflux surgery by identifying their association with each other, preoperative symptoms, and surgical outcomes. . A retrospective review of patients undergoing ureteral reimplant(s) for primary VUR at a tertiary academic medical center between years 2000 and 2014 was done. Preoperative UCx were defined as those within 30 days before surgery. A positive culture was defined as >50,000 colony forming units of a single organism. . A total of 185 patients were identified and 87/185 (47.0%) met inclusion criteria. Of those, 39/87 (45%) completed a preoperative UCx. Only 3/39 (8%) preoperative cultures returned positive, and all of those patients were preoperatively symptomatic. No preoperatively asymptomatic patients had positive preoperative cultures. Intraoperative cultures were obtained in 21/87 (24.1%) patients; all were negative. No associations were found between preoperative culture results and intraoperative cultures or between culture result and postoperative complications. . In asymptomatic patients, no associations were found between the completion of a preoperative or intraoperative UCx and surgical outcomes, suggesting that not all patients may require preoperative screening. Children presenting with symptoms of urinary tract infection (UTI) prior to ureteral reimplantation may benefit from preoperative UCx.
通过确定术前和术中尿液培养(UCx)之间的关联、术前症状及手术结果,来判定其在小儿膀胱输尿管反流(VUR)手术中是否必要。对2000年至2014年间在一家三级学术医疗中心接受原发性VUR输尿管再植术的患者进行回顾性研究。术前UCx定义为手术前30天内的检测结果。培养阳性定义为单一微生物菌落形成单位>50,000。共识别出185例患者,其中87/185(47.0%)符合纳入标准。其中,39/87(45%)完成了术前UCx检测。术前培养仅3/39(8%)呈阳性,且所有这些患者术前均有症状。术前无症状患者的术前培养均为阴性。21/87(24.1%)的患者进行了术中培养,结果均为阴性。术前培养结果与术中培养结果之间以及培养结果与术后并发症之间均未发现关联。在无症状患者中,术前或术中UCx检测的完成情况与手术结果之间未发现关联,这表明并非所有患者都需要进行术前筛查。输尿管再植术前出现尿路感染(UTI)症状的儿童可能会从术前UCx检测中获益。