Liu Xin,Liu Ge,Yang Yi.Predicative factors and optimal timing for surgical repair in children with primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,,18():830-834.[doi:10.3969/j.issn.1671-6353.2019.10.006]
Predicative factors and optimal timing for surgical repair in children with primary vesicoureteral reflux
- CLC:
- R726.9;R693;R699.4
- Abstract:
- Objective To explore the relevant predicative factors and optimal surgical timing in children undergoing corrective surgery for vesicoureteral reflux (VUR).Methods A retrospective study was conducted for 84 children undergoing open surgical repair for VUR from November 2012 to June 2019. Clinical characteristics were collected for identifying the predictors of surgical interventions. And univariate and multivariable analyses were performed using the SPSS version 19 software package. Results Among them,24 cases (28.6%) underwent intravesical ureteroneocystostomy while another 60 (71.4%) were managed conservatively. Based upon multivariable analyses,age,gender,febrile urinary tract infections,maximal grade of reflux,prenatal hydronephrosis and VUR phase of voiding cystourethrogram were not the predictors of eventual surgery. Ureteral dilatation[OR=2.26,95%CI(1.27-4.00)] and maximal grade of reflux[OR=35.70,95%CI(2.87-444.77)] were among the strongest predictors of surgical interventions.Conclusion Higher grades of VUR and ureteral dilatation >7.65 mm were the strongest predictors of eventual surgical interventions.
References:
1 Nordenstr?m J,Sj?str?m S,Sillén U,et al.The Swedish infant high-grade reflux trial:UTI and renal damage[J].J Pediatr Urol,2017,13(2):146-154.DOI:10.1016/j.jpurol.2016.12.023.
2 Szymanski KM,Oliveira LM,Silva A,et al.Analysis of indicationfor ureteral reimplantation in 3738 children with vesicoureteral reflux:a single institutional cohort[J].J Pediatr Urol,2011,7(6):601-610.DOI:10.1016/j.jpurol.2011.06.002.
3 Lebowitz RL,Olbing H,Parkkulainen KV,et al.International system of radiographic grading of vesicoureteric reflux.International Reflux Study in Children[J].Pediatr Radiol,1985,15(2):105-109.DOI:10.1007/bf02388714.
4 Arlen AM,Leong T,Guidos PJ,et al.Distal Ureteral Diameter Ratio is Predictive of Breakthrough Febrile Urinary Tract Infection[J].J Urol,2017,198(6):1418-1423.DOI:10.1016/j.juro.2017.06.095.
5 Peters CA,Skoog SJ,Arant BS Jr,et al.Summary of the AUA guideline on management of primary vesicoureteral reflux in children[J].J Urol,2010,184(3):1134-1144.DOI:10.1016/j.juro.2010.05.065.
6 Stein R,Dogan HS,Hoebeke P,et al.Urinary tract infections in children:EAU/ESPU guidelines[J].Eur Urol,2015,67(3):546-558.DOI:10.1016/j.eururo.2014.11.007.
7 Szlyk GR,Williams SB,Majd M,et al.Incidence of new renal parenchymal inflammatory changes following breakthrough urinary tractinfection in patients with vesicoureteral reflux treated with antibiotic prophylaxis:evaluation by 99M technetium dimercaptosuccinicacid renal scan[J].J Urol,2003,170(4 Pt 2):1566-1568; discussion 1568-1569.DOI:10.1097/01.ju.0000085962.68246.ce.
8 Puri P,Kutasy B,Colhoun E,et al.Single center experience withendoscopic subureteraldextranomer/hyaluronic acid injection as firstline treatment in 1551 children with intermediate and high gradevesicoureteral reflux[J].J Urol,2012,188(4 Suppl):1485-1489.DOI:10.1016/j.juro.2012.02.023.
9 Silva JM,Oliveira EA,Diniz JS,et al.Gender and vesico-ureteralreflux:a multivariable analysis[J].Pediatr Nephrol,2006,21(4):510-516.DOI:10.1007/s00467-006-0011-z.
10 Singh-Grewal D,Macdessi J,Craig J.Circumcision for the prevention of urinary tract infection in boys:a systematic review of randomised trials and observational studies[J].Arch Dis Child,2005,90(8):853-858.DOI:10.1136/adc.2004.049353.
11 Estrada CR Jr,Passerotti CC,Graham DA,et al.Nomograms for predicting annual resolution rate of primary vesicoureteral reflux:resultsfrom 2.462 children[J].J Urol,2009,182(4):1535-1541.DOI:10.1016/j.juro.2009.06.053.
12 Dangle PP,Ayyash O,Bandari J,et al.Clinical and Radiological Risk Factors Predicting Open Surgical Repair in Pediatric Patients With Dilating Vesicoureteral Reflux[J].Urology,2017,99:203-209.DOI:10.1016/j.urology.2016.06.014.
13 Arlen AM,Garcia-Roig M,Weiss AD,et al.Vesicoureteral refluxindex:2-institution analysis and validation[J].J Urol,2016,195(4 Pt 2):1294-1299.DOI:10.1016/j.juro.2015.03.094.
14 Arlen AM,Kirsch AJ,Leong T,et al.Validation of the ureteral diameter ratio for predicting early spontaneous resolution of primary vesicoureteral reflux[J].J Pediatr Urol,2017,13(4):383.e1-383.e6.DOI:10.1016/j.jpurol.2017.01.012.
Memo
收稿日期:2019-09-19。
基金项目:国家自然科学基金(编号:81571514)
通讯作者:杨屹,Email:yangy2@sj-hospital.org