Bukowski T P, Betrus G G, Aquilina J W, Perlmutter A D
Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, USA.
J Urol. 1998 Apr;159(4):1286-9.
For several decades ureteroneocystostomy has been performed in children to correct primary vesicoureteral reflux. A purported indication for antireflux surgery is to prevent significant upper urinary tract infection during pregnancy. We performed a long-term followup of women who underwent antireflux surgery during childhood to determine outcome in regard to urinary tract infection history and pregnancy.
We identified 227 women of childbearing age who underwent ureteral reimplantation for primary vesicoureteral reflux from 1964 through 1981. Of the 122 women contacted 41 had been pregnant (77 total pregnancies). Cystitis or asymptomatic bacteriuria and pyelonephritis developed during 18 and 5 pregnancies, respectively. The 77 pregnancies resulted in 57 term births, 7 voluntary pregnancy interruptions and 13 spontaneous abortions.
Patients who previously underwent successful antireflux surgery continued to have a significant number of urinary tract infections through the intervening years. Despite a higher than expected incidence of pyelonephritis, they had relatively little hypertension and renal insufficiency. During pregnancy the incidence of pyelonephritis was only slightly higher than that of the general population. However, severe complications of pregnancy, such as preeclampsia, premature birth and acute renal failure, occurred more frequently in women with a history of renal scarring or hypertension (7 of 12) than in those with a history of recurrent infection alone (3 of 10).
When renal scarring is present, reflux should be corrected before pregnancy to minimize maternal and fetal morbidity. When scarring is not present, the literature suggests that women with a history of reflux are at increased risk for pyelonephritis during pregnancy whether or not ureterocystostomy was performed. Pregnant women with a history of reflux may benefit from prophylactic antibiotics and women with reflux nephropathy should be followed throughout life.
几十年来，儿童一直通过输尿管膀胱再植术来纠正原发性膀胱输尿管反流。抗反流手术的一个据称适应证是预防孕期严重的上尿路感染。我们对童年期接受抗反流手术的女性进行了长期随访，以确定其尿路感染病史和妊娠结局。
我们确定了1964年至1981年因原发性膀胱输尿管反流接受输尿管再植术的227名育龄女性。在联系的122名女性中，41名已怀孕（共77次妊娠）。分别有18次和5次妊娠期间发生膀胱炎或无症状菌尿以及肾盂肾炎。77次妊娠中有57次足月分娩、7次自愿终止妊娠和13次自然流产。
先前接受成功抗反流手术的患者在随后的几年中仍有大量尿路感染。尽管肾盂肾炎的发生率高于预期，但她们的高血压和肾功能不全相对较少。孕期肾盂肾炎的发生率仅略高于一般人群。然而，有肾瘢痕或高血压病史的女性（12例中的7例）比仅有反复感染病史的女性（10例中的3例）更频繁地出现严重的妊娠并发症，如先兆子痫、早产和急性肾衰竭。
存在肾瘢痕时，应在怀孕前纠正反流，以尽量减少母婴发病率。不存在瘢痕时，文献表明，无论是否进行输尿管膀胱再植术，有反流病史的女性孕期患肾盂肾炎的风险都会增加。有反流病史的孕妇可能从预防性抗生素中获益，而有反流性肾病的女性应终身随访。
