Koff S A, Wagner T T, Jayanthi V R
Ohio State University Medical School and Children's Hospital, Columbus, USA.
J Urol. 1998 Sep;160(3 Pt 2):1019-22. doi: 10.1097/00005392-199809020-00014.
We determine whether functional bladder and/or bowel disorders influence the natural history or treatment of children with primary vesicoureteral reflux.
We assessed 143 children with primary vesicoureteral reflux that stopped spontaneously or was surgically corrected for functional bowel and/or bladder disorders, including bladder instability, constipation and infrequent voiding, termed the dysfunctional elimination syndromes.
Dysfunctional elimination syndromes were present in 66 of 143 children (43%) thought to have primary vesicoureteral reflux. Of these 66 patients 54 (82%) had a breakthrough urinary tract infection and underwent reimplantation compared to only 18% without the syndromes. Of 70 children who had a breakthrough urinary tract infection dysfunctional elimination syndromes were present in 54 (77%) and absent in 16 (23%). Of the remaining 73 patients who did not have a breakthrough infection dysfunctional elimination syndromes were present in 12 (16%) and absent in 61 (84%). In children with dysfunctional elimination syndromes the resolution of reflux that was 1 grade less severe required an average of 1.6 years longer. After the disappearance of reflux, urinary tract infection developed in 18 children, including 14 (78%) with dysfunctional elimination syndromes. Unsuccessful surgical outcomes involving persistent, recurrent and contralateral reflux occurred only in children with dysfunctional elimination syndromes.
Dysfunctional elimination syndromes are common and are often unrecognized in children with primary reflux. These syndromes are associated with delayed reflux resolution and an increased rate of breakthrough urinary tract infection, which leads to reimplantation surgery. Dysfunctional elimination syndromes also adversely affect the results of reimplantation and represent a risk for recurrent urinary tract infection after reflux resolves. The evaluation and management of dysfunctional elimination syndromes should be an integral part of the treatment of every child with vesicoureteral reflux. Effective evaluation and treatment may be made cost-effective by decreasing the followup, the number of breakthrough urinary tract infections and the number of children requiring reimplantation.
我们确定功能性膀胱和/或肠道疾病是否会影响原发性膀胱输尿管反流患儿的自然病程或治疗。
我们评估了143例原发性膀胱输尿管反流患儿，这些患儿的反流自行停止或因功能性肠道和/或膀胱疾病（包括膀胱不稳定、便秘和排尿不频繁，即功能性排尿障碍综合征）而接受了手术矫正。
143例被认为患有原发性膀胱输尿管反流的患儿中，66例（43%）存在功能性排尿障碍综合征。在这66例患者中，54例（82%）发生了突破性尿路感染并接受了再植手术，而无该综合征的患儿中这一比例仅为18%。在70例发生突破性尿路感染的患儿中，54例（77%）存在功能性排尿障碍综合征，16例（23%）不存在。在其余73例未发生突破性感染的患者中，12例（16%）存在功能性排尿障碍综合征，61例（84%）不存在。在患有功能性排尿障碍综合征的患儿中，反流程度减轻1级的消退平均需要延长1.6年。反流消失后，18例患儿发生了尿路感染，其中14例（78%）患有功能性排尿障碍综合征。手术结果不佳，包括持续性、复发性和对侧反流，仅发生在患有功能性排尿障碍综合征的患儿中。
功能性排尿障碍综合征在原发性反流患儿中很常见，且常常未被识别。这些综合征与反流消退延迟和突破性尿路感染发生率增加有关，这会导致再植手术。功能性排尿障碍综合征也会对再植手术的结果产生不利影响，并代表反流消退后复发性尿路感染的风险。功能性排尿障碍综合征的评估和管理应成为每个膀胱输尿管反流患儿治疗的一个组成部分。通过减少随访、突破性尿路感染的数量和需要再植手术的患儿数量，有效的评估和治疗可能会具有成本效益。
