Greenfield S P, Ng M, Wan J
Department of Pediatric Urology, Children's Hospital, State University of New York, Buffalo School of Medicine, USA.
J Urol. 1997 Apr;157(4):1410-3.
Most children with grades I to III primary vesicoureteral reflux are monitored for years on antibiotic prophylaxis until reflux resolves. While the overall resolution rate of these grades is known, the rates for various patient ages at presentation are unknown. Therefore, we examined resolution rates of these grades for different ages at presentation.
From 1985 through 1990, 168 boys (245 ureters) and 433 girls (590 ureters) with all grades of reflux were enrolled in the study and monitored through the end of 1993. Urine cultures were obtained every 4 months and contrast voiding cystourethrography was repeated every 18 months. Age at presentation was stratified into groups younger than 1, 1 to 3, 4 to 6, 7 to 9, and 10 years and older. Resolution rates were then calculated for grades I to III reflux for each age at presentation. Time to resolution was also evaluated for each age and grade.
There were no significant differences between rates of resolution at different ages for each grade. Children less than 10 years old had as high a likelihood of resolution as infants. Neither sex nor bilaterality versus unilaterality was a helpful predictor of resolution. Time to resolution varied widely and it was also not helpful for identifying the cases of reflux that resolved.
Low grade vesicoureteral reflux may not resolve until adolescence and age at presentation is not a reliable predictive factor. Children should remain on prophylaxis for many years unless definitive correction is undertaken.
大多数I至III级原发性膀胱输尿管反流患儿需接受数年抗生素预防治疗，直至反流消失。虽然已知这些分级的总体消失率，但不同就诊年龄患者的消失率尚不清楚。因此，我们研究了不同就诊年龄这些分级的消失率。
1985年至1990年，168名男孩（245条输尿管）和433名女孩（590条输尿管），患有各级反流，被纳入研究并监测至1993年底。每4个月进行一次尿培养，每18个月重复一次排尿性膀胱尿道造影。就诊年龄分为小于1岁、1至3岁、4至6岁、7至9岁和10岁及以上几组。然后计算每个就诊年龄I至III级反流的消失率。还评估了每个年龄和分级的消失时间。
各分级在不同年龄的消失率之间无显著差异。10岁以下儿童与婴儿的消失可能性一样高。性别以及双侧反流与单侧反流均不是消失的有效预测因素。消失时间差异很大，对识别已消失的反流病例也无帮助。
低级别膀胱输尿管反流可能直到青春期才会消失，就诊年龄不是一个可靠的预测因素。除非进行确定性矫正，否则儿童应接受多年的预防治疗。
