Läckgren Göran, Cooper Christopher S, Neveus Tryggve, Kirsch Andrew J
Section of Urology, Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden.
Department of Urology, University of Iowa, Iowa City, IA, United States.
Front Pediatr. 2021 Mar 31;9:650326. doi: 10.3389/fped.2021.650326. eCollection 2021.
Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. We review advancements over the last two decades in our understanding and management of VUR. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often involved. Some factors that increase the likelihood of persistence (e.g., high grade) also increase the risk of renal scarring. Voiding cystourethrography (VCUG) is generally considered the definitive method for diagnosing VUR, and helpful in determining the need for treatment. However, this procedure causes distress and radiation exposure. Therefore, strategies to reduce clinicians' reliance upon VCUG (e.g., after a VUR treatment procedure) have been developed. There are several options for managing patients with VUR. Observation is suitable only for patients at low risk of renal injury. Antibiotic prophylaxis can reduce the incidence of UTIs, but drawbacks such as antibiotic resistance and incomplete adherence mean that this option is not viable for long-term use. Long-term studies of endoscopic injection have helped us understand factors influencing use and the effectiveness of this procedure. Ureteral reimplantation is still performed commonly, and robot-assisted laparoscopic methods are gaining popularity. Over the last 20 years, there has been a shift toward more conservative management of VUR with an individualized, risk-based approach. For continued treatment improvement, better identification of children at risk of renal scarring, robust evidence regarding the available interventions, and an improved VUR grading system are needed.
膀胱输尿管反流（VUR）与尿路感染、肾瘢痕形成及反流性肾病风险增加相关。我们回顾过去二十年来在VUR的认识和管理方面取得的进展。随着时间推移，该病症可能会自发缓解，但也可能持续多年，且常伴有膀胱/肠道功能障碍。一些增加病症持续可能性的因素（如高级别反流）也会增加肾瘢痕形成的风险。排尿性膀胱尿道造影（VCUG）通常被认为是诊断VUR的金标准方法，有助于确定是否需要治疗。然而，该检查会给患者带来不适并使其受到辐射。因此，已制定了一些策略来减少临床医生对VCUG的依赖（如在VUR治疗术后）。治疗VUR患者有多种选择。观察仅适用于肾损伤风险较低的患者。抗生素预防可降低尿路感染的发生率，但抗生素耐药性和依从性不完全等缺点意味着该方法不适用于长期使用。内镜注射的长期研究有助于我们了解影响该治疗方法使用及效果的因素。输尿管再植术仍被广泛应用，机器人辅助腹腔镜手术方法也越来越受欢迎。在过去20年中，VUR的管理已转向更保守的、基于个体风险的方法。为持续改善治疗效果，需要更好地识别有肾瘢痕形成风险的儿童，获取关于现有干预措施的有力证据，并改进VUR分级系统。
