Han Wenwen,Zhang Weiping.Managements of primary vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,2025,(07):601-604.[doi:10.3760/cma.j.cn101785-202503068-001]
儿童原发性膀胱输尿管反流治疗方法述评
- Title:
- Managements of primary vesicoureteral reflux in children
- Keywords:
- Vesico-Ureteral Reflux; Urologic Diseases; Infections; Surgical Procedures; Operative; Child
- 摘要:
- 原发性膀胱输尿管反流是儿童常见的泌尿系畸形,由于输尿管膀胱连接部活瓣样功能受损,导致尿液逆流人输尿管和肾,引起反复泌尿系感染、肾瘢痕、高血压,甚至肾衰竭,需及时诊断和治疗。儿童原发性膀胱输尿管反流治疗方案众多,主要分为保守治疗及手术治疗两种,本文就各种治疗方案进行讨论,并对每种治疗方案进行详细述评。
- Abstract:
- Primary vesicoureteral reflux(PVUR)is a common urinary malformation in children.It is caused by immaturity or structural abnormality of ureterovesical junction,resulting in a failure of normal antire-flux mechanism,recurrent urinary tract infections,kidney scars,hypertension and even renal failure.Therefore timely diagnosis and intervention are required.Currently there are many conservative and surgical options for PVUR in children.This review focused upon individual treatments and their detailed discussions.
参考文献/References:
[1] Hari P, Meena J, Kumar M, et al.Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux[J]. Pediatr Nephrol, 2024, 39(5):1639-1668.DOI:10.1007/s00467-023-06173-9.
[2] Passoni NM, Peters CA.Modern management of vesicoureteral reflux:envisioning a future with individualized therapies[J]. Eur Urol, 2024, 85(5):443-444.DOI:10.1016/j.eururo.2024.02. 002.
[3] Naseri M, Tafazoli N, Tafazoli N.Prevalence of vesicoureteral reflux in children with urinary tract infection[J]. Saudi J Kidney Dis Transpl, 2022, 33(Supplement):S111-S120.DOI:10.4103/1319-2442. 384183.
[4] Williams G, Craig JC.Long-term antibiotics for preventing recurrent urinary tract infection in children[J]. Cochrane Database Syst Rev, 2019, 4(4):CD001534.DOI:10.1002/14651858.CD001534.pub4.
[5] Dias CS, Silva JMP, Diniz JSS, et al.Risk factors for recurrent urinary tract infections in a cohort of patients with primary vesicoureteral reflux[J]. Pediatr Infect Dis J, 2010, 29(2):139-144.DOI:10.1097/inf.0b013e3181b8e85f.
[6] Su DQ, Shen Q, Zhai YH, et al.Risk factors for breakthrough urinary tract infection in children with vesicoureteral reflux receiving continuous an-tibiotic prophylaxis[J]. Transl Pediatr, 2022, 11(1):1-9.DOI:10.21037/tp-21-398.
[7] Wang ZT, Wehbi E, Alam Y, et al.A reanalysis of the RIVUR trial using a risk classification system[J]. J Urol, 2018, 199(6):1608-1614.DOI:10.1016/j, juro.2017.11. 080.
[8] Mattoo TK, Mohammad D.Primary vesicoureteral reflux and renal scarring[J]. Pediatr Clin North Am, 2022, 69(6):1115-1129.DOI:10.1016/j.pel.2022.07. 007.
[9] Morello W, Baskin E, Jankauskiene A, et al.Antibiotic prophylaxis in infants with grade Ⅲ, IV, or V vesicoureteral reflux[J]. N Engl J Med, 2023, 389(11):987-997.DOI:10.1056/NEJMoa2300161.
[10] Shahrokhzadeh S, Soleimani A, Kordi-Tamandani DM, et al.Association of genetic polymorphisms in GSTP1, GSTM1, and GSTT1 genes with vesi-coureteral reflux susceptibility in the children of Southeast Iran[J]. Iran J Public Health, 2020, 49(7):1364-1371.DOI:10.18502/ijph.v49i7. 3591.
[11] Nickavar A, Sotoudeh K.Treatment and prophylaxis in pediatric urinary tract infection[J]. Int J Prev Med, 2011, 2(1):4-9.
[12] Tekgül S, Riedmiller H, Hoebeke P, et al.EAU guidelines on vesicoureteral reflux in children[J]. Eur Urol, 2012, 62(3):534-542.DOI:10. 1016/j.eururo.2012.05.059.
[13] Gnech M, Hoen L, Zachou A, et al.Update and summary of the European association of urology/European society of paediatric urology paediatric guidelines on vesicoureteral reflux in children[J]. Eur Urol, 2024, 85(5):433-442.DOI:10.1016/j.eururo.2023.12. 005.
[14] Chan JY, Khondker A, Lee MJ, et al.The role of circumcision in preventing urinary tract infections in children with antenatal hydronephrosis:sys-tematic review and meta-analysis[J]. J Pediatr Urol, 2023, 19(6):766-777.DOI:10.1016/j.jpurol.2023. 07.017.
[15] Peters CA, Skoog SJ, Arant BS, 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.
[16] 黄轶展.儿童原发性膀胱输尿管反流专家共识[J].临床小儿外科杂志, 2019, 18(10):811-816.DOI:10.3969/j.issn.1671-6353. 2019. 10.002. Huang YC.Expert consensus on primary vesicoureteral reflux in children[J]. J Clin Ped Sur, 2019, 18(10):811-816.DOI:10.3969/j.issn. 1671-6353.2019.10.002.
[17] Raziye Ergun, Cagri Akin Sekerci, Yiloren Tanidir, et al.Abnormal DMSA renal scan findings and associated factors in older children with vesi-coureteral reflux[J]. Int Urol Nephrol, 2021, 53(10):1963-1968.DOI:10.1007/s11255-021-02934-3.
[18] 孙宁,张滩平,黄澄如.实用小儿泌尿外科学[M].第2版.北京:人民卫生出版社, 2023:232-237. Sun N, Zhang WP, Huang CR.Practical Pediatric Urology[M]. translated.2nd ed.Beijing:People’s Medical Publishing House, 2023:232-237.
[19] Duckett JW, Walker RD, Weiss R.Surgical results:International Reflux Study in Children-United States branch[J]. J Urol, 1992, 148(5 Pt 2):1674-1675.DOI:10.1016/s0022-5347(17)36999-9.
[20] Kutasy B, Coyle D.History of endoscopic treatment of vesicoureteral reflux[J]. Pediatr Surg Int, 2023, 39(1):187.DOI:10.1007/s00383-023-05468-0.
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备注/Memo
收稿日期:2025-3-19。
基金项目:北京市科委中关村管委会"医药创新品种及平台培育"专项(Z231100004823034)
通讯作者:张潍平,Email:zhangwpp@163.com