Lottmann H, Aigrain Y
Presse Med. 1996 Feb 10;25(5):185-7.
Primary vesicoureteral reflux is a frequent condition threatening the renal parenchyma. This severe disease can lead to renal dysplasia and scarring. When revealed by acute urinary tract infection, parenchymal damage has, in most cases, already occurred so medical or surgical care comes too late. Ideally, the population should be screened at birth for vesicoureteral reflux, but unfortunately, no biological test is yet available. At the present time, it would be reasonable to propose cystography to "at risk" populations, first in newborns with pyelocaliceal dilation detected antenatally then in siblings of patients treated for vesicoureteral reflux. Bladder dysfunction, also often associated with primary vesicoureteral reflux, should be identified early and treated. Finally there are several, often opposing, patterns of clinical expression. Antenatally detected vesicoureteral reflux predominates in the male population. Congenital parenchymal lesions, even in the absence of urinary tract infection, are associated with a small capacity hyperactive bladder. Primary vesicoureteral reflux in the school-age girl is associated with post-infectious renal scarring and with a large bladder incompletely emptied during micturition. Early diagnosis, screening of high-risk populations and prevention of infection together with better management of bladder dysfunction should help reduce the incidence of parenchymal damage due to primary vesicoureteral reflux.
原发性膀胱输尿管反流是一种常见的威胁肾实质的疾病。这种严重疾病可导致肾发育不良和瘢痕形成。当由急性尿路感染揭示时，在大多数情况下实质损害已经发生，因此药物或手术治疗为时已晚。理想情况下，应在出生时对人群进行膀胱输尿管反流筛查，但不幸的是，尚无生物学检测方法。目前，对“高危”人群建议进行膀胱造影是合理的，首先是对产前检测到肾盂肾盏扩张的新生儿，然后是对接受膀胱输尿管反流治疗的患者的兄弟姐妹。膀胱功能障碍也常与原发性膀胱输尿管反流相关，应尽早识别并治疗。最后，有几种临床表型，常常相互对立。产前检测到的膀胱输尿管反流在男性人群中占主导。先天性实质病变，即使在没有尿路感染的情况下，也与小容量高活性膀胱相关。学龄期女孩的原发性膀胱输尿管反流与感染后肾瘢痕形成以及排尿时膀胱排空不完全相关。早期诊断、高危人群筛查、感染预防以及更好地管理膀胱功能障碍应有助于降低原发性膀胱输尿管反流所致实质损害的发生率。
