Edwards D, Normand I C, Prescod N, Smellie J M
Br Med J. 1977 Jul 30;2(6082):285-8. doi: 10.1136/bmj.2.6082.285.
Seventy-five children aged 3 weeks to 12 years and found on investigation of symptomatic urinary infection to have vesicoureteric reflux were managed conservatively with continuous low-dose prophylaxis. Serial cystographic and renal growth studies were performed during seven to 15 years' follow-up. Reflux disappeared spontaneously in 53 children (71%) and from 79% of the affected ureters. This occurred at any age and not only in infancy or at puberty. The initial severity or reflux was the most important factor affecting the outcome. Reflux disappeared from 85% of ureters of normal calibre but from only 41% of dilated ureters. Gross reflux associated with existing severe renal scarring was least likely to disappear. Nevertheless, reflux stopped in 12 of the 19 initially scarred renal units (63%). Reflux was as likely to disappear in children who had a recurrence of urinary infection as in those who had no further infection. Renal growth appeared to be normal in 93% of kidneys and fresh or extending scarring was seen in only two children. Management programmes for children with vesicoureteric reflux should take into account the self-limiting nature of three-quarters of the reflux found on investigating uncomplicated urinary tract infection.
对75名年龄在3周龄至12岁之间、因有症状性泌尿道感染经检查发现存在膀胱输尿管反流的儿童进行了持续低剂量预防性保守治疗。在7至15年的随访期间进行了系列膀胱造影和肾脏生长研究。53名儿童（71%）的反流自发消失，占受累输尿管的79%。这在任何年龄都可能发生，并非仅在婴儿期或青春期。反流初始严重程度是影响结局的最重要因素。正常管径输尿管的反流85%消失，但扩张输尿管的反流仅41%消失。与现存严重肾瘢痕相关的重度反流最不可能消失。然而，19个最初有瘢痕的肾单位中有12个（63%）反流停止。有泌尿道感染复发的儿童与无进一步感染的儿童相比，反流消失的可能性相同。93%的肾脏生长似乎正常，仅两名儿童出现新的或扩展的瘢痕。对于膀胱输尿管反流儿童的管理方案应考虑到在调查非复杂性泌尿道感染时发现的四分之三反流具有自限性这一特点。
