Long Christopher J, Bowen Diana K
Division of Urology, Children's Hospital of Philadelphia, 3rd Floor Wood Center, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Curr Urol Rep. 2018 May 17;19(7):55. doi: 10.1007/s11934-018-0801-4.
The purpose of this review is to bring the reader up to date on the current risk factors for the development of renal deterioration in the boys with posterior urethral valves (PUV) and approaches to modify this risk.
Renal bladder ultrasound (RBUS) is routinely performed in boys with PUV and recent advancements allow imaging processing that can more accurately quantify renal parenchyma and correlate this with risk for renal loss. Refinement of urine studies may improve our ability to stratify patients into renal loss categories. Use of videourodynamics (VUDS) allows refined assessment of the valve bladder to identify those who might benefit from secondary procedures and/or the addition of targeted pharmacotherapy to improve bladder emptying or dangerous storage pressures. All boys with a history of PUV are at a significant long-term risk of renal deterioration. The literature suggests that several technical advances have improved our ability to predict this risk, although there needs to be further refinement and validation before widespread use. Utilization of close follow-up, VUDS, pharmacotherapy, and bladder drainage provide the best methods to improve care to this group of patients and if more studies confirm their utility, adoption of these as part of standard of care protocols may be warranted.
本综述旨在使读者了解后尿道瓣膜（PUV）男孩发生肾脏恶化的当前风险因素以及降低该风险的方法。
肾膀胱超声（RBUS）是对患有PUV的男孩进行的常规检查，最近的进展使成像处理能够更准确地量化肾实质，并将其与肾丢失风险相关联。尿液检查的改进可能会提高我们将患者分层到肾丢失类别的能力。使用视频尿动力学（VUDS）可以更精确地评估瓣膜膀胱，以确定哪些患者可能从二次手术和/或添加靶向药物治疗中受益，从而改善膀胱排空或危险的膀胱内压。所有有PUV病史的男孩都面临着显著的长期肾脏恶化风险。文献表明，尽管在广泛应用之前还需要进一步完善和验证，但一些技术进步已经提高了我们预测这种风险的能力。密切随访、VUDS、药物治疗和膀胱引流的应用为改善对这组患者的治疗提供了最佳方法，如果更多研究证实其效用，将这些作为标准护理方案的一部分可能是合理的。
