Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
Pediatric Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Pediatr Surg Int. 2023 Aug 17;39(1):249. doi: 10.1007/s00383-023-05535-6.
To evaluate UDR reliability, sensitivity, specificity and to identify the best treatment basing on UDR among single or double endoscopic injections and ureteral reimplantation.
Data of patients affected by primary VUR and treated by endoscopic injection over a 10 years period were retrospectively analyzed. Two radiologist attributed reflux grade and UDR on voiding cystourethrogram twice and blinded. Follow-up focused on resolution after 1 or 2 endoscopic injections. Relation between UDR, reflux grade and outcomes were analyzed.
Patient enrolled were 198. Low grade VUR was present in 24.8%, grade 3 in 41.6%, grade 4-5 in 33.6%. Resolution after one injection was obtained in 88 patients; among 110 not resolved 104 cases had a second injection. Success after 2 injections was reported in 138 cases. UDR showed a higher reliability compared with reflux grade both in intra than inter-reader measurement (ICC > 90%). Success after 1 or 2 injections was reported for UDR < 0.33 and UDR < 0.47 respectively.
UDR shows to be a more reliable measurement that allows for an objective estimation of VUR severity and prognosis. It represents a quantitative parameter that might be useful to identify patients who may benefit endoscopic or surgical treatment, avoiding unnecessary under or over-treatment.
评估 UDR 的可靠性、灵敏度、特异度，并在单或双内镜下注射和输尿管再植入术之间，根据 UDR 确定最佳治疗方案。
回顾性分析了 10 年间接受内镜注射治疗的原发性 VUR 患者的数据。两名放射科医生在两次排尿性膀胱尿道造影时对反流程度和 UDR 进行评估，并进行双盲操作。随访重点关注 1 或 2 次内镜注射后的缓解情况。分析 UDR、反流程度与结局之间的关系。
共纳入 198 名患者。低级别 VUR 占 24.8%，3 级占 41.6%，4-5 级占 33.6%。88 名患者在 1 次注射后得到缓解；110 名未缓解的患者中有 104 例接受了第 2 次注射。138 例患者在接受 2 次注射后获得成功。UDR 在内部和外部读者测量中均比反流分级具有更高的可靠性（ICC>90%）。UDR<0.33 和 UDR<0.47 时，分别报告 1 或 2 次注射后成功。
UDR 是一种更可靠的测量方法，可客观评估 VUR 的严重程度和预后。它是一种定量参数，可能有助于识别可能受益于内镜或手术治疗的患者，避免不必要的过度或不足治疗。
