Scholtmeijer R J, Nijman R J
Department of Pediatric Urology, Erasmus University, Sophia Children's Hospital, Rotterdam, The Netherlands.
Urology. 1994 May;43(5):714-8. doi: 10.1016/0090-4295(94)90194-5.
To study prospectively the influence of videourodynamic studies on the management of children with vesicoureteric reflux.
One hundred one children with reflux were investigated routinely with videourodynamic studies, as well as renal scans, ultrasound studies, and/or intravenous urograms. The studies were repeated at one, three, and five years. If bladder instability was demonstrated, the primary treatment consisted of anticholinergic drugs and antibiotics, regardless of the grade of reflux. In reflux Grades IV and V with instability and renal scars, surgery was performed. In case of a stable bladder, reflux Grades I-III received antibacterial treatment, while surgical correction was used for reflux Grades IV and V.
The results of three years of follow-up of 101 children are reported. Bladder instability was found in 39 children. Thirty of them with reflux Grades I-IV and instability could be managed with anticholinergic and antibacterial drugs, while 9 needed surgical correction.
A voiding cystourethrogram is only sufficient for the detection of reflux but for correct management of these children a (video)urodynamic study is mandatory. After treatment of frequently found bladder dysfunction, the reflux will disappear in the majority of cases.
前瞻性研究影像尿动力学检查对膀胱输尿管反流患儿治疗的影响。
101例反流患儿接受了常规的影像尿动力学检查，以及肾脏扫描、超声检查和/或静脉肾盂造影。在1年、3年和5年时重复检查。如果证实存在膀胱不稳定，无论反流分级如何，主要治疗包括抗胆碱能药物和抗生素。对于伴有不稳定和肾脏瘢痕的IV级和V级反流，进行手术治疗。对于膀胱稳定的患儿，I-III级反流接受抗菌治疗，而IV级和V级反流则采用手术矫正。
报告了101例患儿3年的随访结果。39例患儿存在膀胱不稳定。其中30例I-IV级反流且伴有不稳定的患儿可通过抗胆碱能药物和抗菌药物治疗，而9例需要手术矫正。
排尿性膀胱尿道造影仅足以检测反流，但对于这些患儿的正确治疗，（影像）尿动力学检查是必需的。在治疗常见的膀胱功能障碍后，大多数情况下反流会消失。
