Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, Naples, Italy.
Eur Radiol. 2024 Oct;34(10):6369-6375. doi: 10.1007/s00330-024-10768-7. Epub 2024 Apr 22.
To compare characteristics and outcomes of vesicoureteral reflux (VUR) detected solely on isotopic cystography (IC) ("occult" VUR) with voiding cystourethrography (VCUG)-detected VUR.
Between 2015 and 2020, we retrospectively enrolled all male children first undergoing VCUG and, if negative, IC in the same session. Kidney injury (KI) was defined by abnormal estimated glomerular filtration rate and/or blood pressure and/or proteinuria.
We enrolled 421 males with a median age of 3 months and a follow-up of 5.3 years. None exhibited KI initially, but 10% of those with VUR developed KI during follow-up. Two hundred and twenty-two patients (52.7%) did not show VUR, 152 (36.1%) had VCUG-diagnosed VUR, and 47 (11.2%) had occult VUR. Therefore, 47/199 patients (23.6%) with VUR had occult VUR. Among these, 34/47 (72.3%) had dilated VUR, and 22/47 (46.8%) exhibited split renal function < 45% and/or scar (scintigraphic damage). Compared to patients with occult VUR, those with VCUG-diagnosed VUR showed a similar prevalence of febrile urinary tract infection (fUTI) before and after VUR diagnostics and KI at the last follow-up but a higher prevalence of dilated VUR, of scintigraphic damage, and underwent surgery more frequently. At multiple logistic regression analysis, patients with VCUG-diagnosed VUR presented an increased risk of fUTI either before or after VUR diagnosis and of KI, while patients with occult VUR presented an increased risk of fUTI before (and among patients with dilated VUR also after) VUR diagnosis and of KI.
Occult VUR affects 23.6% of male children with VUR with a non-negligible risk of VUR-associated KI and fUTI. IC could select, among males with recurrent fUTIs and negative VCUG, those requiring surgery for a possible dilated occult VUR.
Vesicoureteral reflux may be overlooked in 25% of boys during VCUG, yet they are at risk of fUTIs and KI. In case of recurrent infections post-negative cystourethrography, IC could detect occult reflux, guiding surgical intervention.
比较同位素膀胱造影（IC）检测到的单纯性（“隐匿性”）膀胱输尿管反流（VUR）与排尿性膀胱尿道造影（VCUG）检测到的 VUR 的特征和结局。
在 2015 年至 2020 年期间，我们回顾性地纳入了所有首先接受 VCUG 检查且结果为阴性的男性患儿，并在同一次检查中进行 IC。肾脏损伤（KI）定义为肾小球滤过率和/或血压和/或蛋白尿异常。
我们纳入了 421 名中位年龄为 3 个月的男性患儿，随访时间为 5.3 年。最初无患儿出现 KI，但在随访期间，10%的 VUR 患儿出现 KI。222 名患儿（52.7%）未出现 VUR，152 名患儿（36.1%）VCUG 诊断为 VUR，47 名患儿（11.2%）存在隐匿性 VUR。因此，199 名 VUR 患儿中有 47 名（23.6%）存在隐匿性 VUR。其中，34 名（72.3%）存在扩张性 VUR，22 名（46.8%）存在分肾功能<45%和/或瘢痕（闪烁扫描损害）。与 VCUG 诊断为 VUR 的患儿相比，隐匿性 VUR 患儿在 VUR 诊断前后出现发热性尿路感染（fUTI）和最后一次随访时 KI 的发生率相似，但扩张性 VUR、闪烁扫描损害和手术治疗的发生率更高。在多因素逻辑回归分析中，VCUG 诊断为 VUR 的患儿出现 VUR 诊断前后 fUTI 和 KI 的风险增加，而隐匿性 VUR 的患儿出现 VUR 诊断前（且扩张性 VUR 患儿也出现 VUR 诊断后）fUTI 和 KI 的风险增加。
隐匿性 VUR 影响 23.6%的男性 VUR 患儿，存在与 VUR 相关的 KI 和 fUTI 不可忽视的风险。IC 可在复发性 fUTI 且 VCUG 阴性的男性患儿中选择存在可能扩张性隐匿性 VUR 且需要手术的患儿。
在 VCUG 中，25%的男孩可能会漏诊 VUR，但他们存在发生 fUTI 和 KI 的风险。在排尿性膀胱尿道造影检查结果为阴性后的复发性感染情况下，IC 可检测到隐匿性反流，指导手术干预。
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