Aboutaleb Hamdy, Abouelgreed Tamer A, El-Hagrasi Hala, Bakry Eldib Diaa, Abdelaal Mohamed A, El Gohary Mohamed Amin
Department of Urology, Menoufia University, Shibin Al Kawm, Egypt.
Burjeel Hospital, Abu Dhabi, UAE.
Adv Urol. 2022 Apr 26;2022:9697931. doi: 10.1155/2022/9697931. eCollection 2022.
To study the association of the grade of vesicoureteral reflux (VUR) and urinary tract infections (UTI) with renal scarring at the first clinical presentation of patients who underwent antireflux surgery. . Between 2015 and 2020, 150 patients (194 units) who underwent antireflux surgery had dimercaptosuccinic acid (DMSA) renal scans preoperatively. Patients were classified into the nonscar and scar groups according to DMSA scan results. Moreover, cases were classified into afebrile UTI, febrile UTI, and antenatal hydronephrosis (ANH) according to the mode of presentation. We correlated the mode of presentation and the grade of VUR to the presence/absence of renal scars in both groups.
The mean follow-up was 45 months preoperatively. The mode of presentation was afebrile, febrile UTIs, and antenatal hydronephrosis in (50, 14), (20, 46), and (10, 10) patients in the nonscar and scar groups, respectively. Of the 20 patients who presented ANH, 10 (50%) had scars. Clinical presentation was correlated to the presence of renal scarring and its degree. The scar group had significantly higher grades of VUR than the nonscar group (grades I-II (50 units versus 10 units), grade III (28 units versus 40 units), and grade IV-V (22 units versus 44 units) for the nonscar versus scar groups, respectively (value <0.001).
Renal scarring is associated with higher grades of reflux and urinary tract infections. We advocate further research investigating infants who had UTIs with or without fever for early detection of reflux.
研究在接受抗反流手术患者首次临床就诊时，膀胱输尿管反流（VUR）分级及尿路感染（UTI）与肾瘢痕形成之间的关联。2015年至2020年期间，150例接受抗反流手术的患者（194个单位）术前进行了二巯基丁二酸（DMSA）肾扫描。根据DMSA扫描结果将患者分为无瘢痕组和瘢痕组。此外，根据临床表现模式将病例分为无发热性UTI、发热性UTI和产前肾积水（ANH）。我们将两组患者的临床表现模式和VUR分级与肾瘢痕的有无进行了关联分析。
术前平均随访45个月。无瘢痕组和瘢痕组患者的临床表现模式分别为无发热性、发热性UTI和产前肾积水的患者有（50, 14）、（20, 46）和（10, 10）例。在出现ANH的20例患者中，10例（50%）有瘢痕。临床表现与肾瘢痕的存在及其程度相关。瘢痕组的VUR分级显著高于无瘢痕组（无瘢痕组与瘢痕组的I-II级分别为50个单位对10个单位，III级为28个单位对40个单位，IV-V级为22个单位对44个单位）（P值<0.001）。
肾瘢痕形成与更高分级的反流及尿路感染相关。我们主张进一步研究对有或无发热性UTI的婴儿进行早期反流检测。
