Li Yi,Zhang Weiping,Yang Qinglin.Recent advances of surgery for primary vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,2019,18(10):805-810.[doi:10.3969/j.issn.1671-6353.2019.10.001]
儿童原发性膀胱输尿管反流手术治疗的新进展
- Title:
- Recent advances of surgery for primary vesicoureteral reflux in children
- Keywords:
- Vesico-Ureteral Reflux; Surgical Procedures; Operative; Therapy; Child
- 分类号:
- R726.9;R693;R699.4
- 摘要:
- 膀胱输尿管反流（vesicoureteral reflux，VUR）是儿童常见的泌尿系统疾病之一，具有高自发消退率，治疗重点主要是预防及治疗发热性尿路感染（urinary tract infection，UTI）及肾脏瘢痕形成，目前的治疗更加注重个体化。治疗目的是预防控制尿路感染及肾脏瘢痕形成、保护肾脏功能。VUR的治疗以保守观察及抗生素预防治疗为主。手术作为经保守治疗无效的治疗方法已趋于成熟，开放性手术治疗VUR具有疗效确切，适用范围广，成功率高的特点。随着内镜、腹腔镜及机器人手术技术的发展，VUR的手术治疗在微创及快速康复等方面取得了明显进步。
- Abstract:
- Vesicoureteral reflux (VUR) is one of the most common urinary tract abnormalities in children with a high rate of spontaneous regression.Currently its treatment has become more and more individualized.The objectives of treatment are preventing urinary tract infection and kidney scar formation and protecting kidney function.The treatment is based upon conservative observations and antibiotic prophylaxis.Surgery has become more and more mature as an option for ineffective conventional treatment of VUR.Open surgery of VUR offers a definite efficacy with wide applications and high success rate.With the rapid developments of endoscopic,laparoscopic and robotic surgery techniques,surgical treatment of VUR has made tremendous progress for mini-invasiveness and rapid rehabilitation.
参考文献/References:
1 Sargent MA.What is the normal prevalence of vesicoureteral reflux?[J].Pediatr Radiol,2000,30(9):587-593.DOI:10.1007/s002470000263.
2 Chand DH,Rhoades T,Poe SA,et al.Incidence and severity of vesicoureteral reflux in children related to age,gender,race and diagnosis[J].J Urol,2003,170(4 Pt 2):1548-1550.DOI:10.1097/01.ju.0000084299.55552.6c.
3 Quirino IG,Diniz JS,Bouzada MC,et al.Clinical course of 822 children with prenatally detected nephrouropathies[J].Clin J Am Soc Nephrol,2012,7(3):444-451.DOI:10.2215/CJN.03400411.
4 Lama G,Russo M,De Rosa E,et al.Primary vesicoureteric reflux and renal damage in the first year of life[J].Pediatr Nephrol,2000,15(3-4):205-210.DOI:10.1007/s004670000455.
5 Hajiyev P,Burgu B.Contemporary Management of Vesicoureteral Reflux[J].Eur Urol Focus,2017,3(2-3):181-188.DOI:10.1016/j.euf.2017.08.012.
6 Roupret M,Babjuk M,Comperat E,et al.European association of urology guidelines on upper urinary tract urothelial carcinoma:2017 update[J].Eur Urol,2018,73(1):111-122.DOI:10.1016/j.eururo.2017.07.036.
7 Radmayr C,Bogaert G,Dogan HS,et al.EAU Guidelines on Paediatric Urology[EB/OL].[2019-10-10].https://uroweb.org/guideline/paediatric-urology/
8 Straub J,Apfelbeck M,Karl A,et al.Vesico-ureteral reflux:Diagnosis and treatment recommendations[J].Urologe A,2016,55(1):27-34.DOI:10.1007/s00120-015-0003-3.
9 Elder JS,Diaz M.Vesicoureteral reflux-the role of bladder and bowel dysfunction[J].Nat Rev Urol,2013,10(11):640-648.DOI:10.1038/nrurol.2013.221.
10 Shaikh N,Mattoo TK,Keren R,et al.Early antibiotic treatment for pediatric febrile urinary tract infection and renal scarring[J].JAMA Pediatr,2016,170(9):848-854.DOI:10.1001/jamapediatrics.2016.1181.
11 Hidas G,Nam A,Soltani T,et al.Primary vesico-ureteric reflux:The need for individualised risk stratification[J].Arab J Urol,2013,11(1):8-12.DOI:10.1016/j.aju.2012.11.006.
12 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.
13 Hoberman A,Chesney RW,Investigators RT.Antimicrobial prophylaxis for children with vesicoureteral reflux[J].N Engl J Med,2014,371(11):1072-1073.DOI:10.1056/NEJMc1408559.
14 Keren R,Shaikh N,Pohl H,et al.Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring[J].Pediatrics,2015,136(1):e13-21.DOI:10.1542/peds.2015-0409.
15 Bauer SB,Austin PF,Rawashdeh YF,et al.International Children’s Continence Society’s recommendations for initial diagnostic evaluation and follow-up in congenital neuropathic bladder and bowel dysfunction in children[J].Neurourol Urodyn,2012,31(5):610-614.DOI:10.1002/nau.22247.
16 Lorenzo AJ,Rickard M,Santos JD.The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children[J].Pediatr Nephrol,2019,DOI:10.1007/s00467-019-4193-610.1007/s00467-019-4193-6.
17 Braga LH,Rickard M,Farrokhyar F,et al.Bladder training video versus standard urotherapy for bladder and bowel dysfunction:a noninferiority randomized,controlled trial[J].J Urol,2017,197(3 Pt 2):877-884.DOI:10.1016/j.juro.2016.08.089.
18 Mason MD,Stephany HA,Casella DP,et al.Prospective evaluation of sacral neuromodulation in children:outcomes and urodynamic predictors of success[J].J Urol,2016,195(4 Pt 2):1239-1244.10.1016/j.juro.2015.11.034.
19 Rushton HG.Commentary to ‘renal damage detected by dmsa despite normal renal ultrasound in children with febrile uti’[J].J Pediatr Urol,2015,11(3):129-130.DOI:10.1016/j.jpurol.2015.02.006.
20 Copp HL,Nelson CP,Shortliffe LD,et al.Compliance with antibiotic prophylaxis in children with vesicoureteral reflux:results from a national pharmacy claims database[J].J Urol,2010,183(5):1994-1999.DOI:10.1016/j.juro.2010.01.036.
21 Blais AS,Bolduc S,Moore K.Vesicoureteral reflux:From prophylaxis to surgery[J].Can Urol Assoc J,2017,11(1-2Suppl1):S13-S18.DOI:10.5489/cuaj.4342.
22 Rosman BM,Passerotti CC,Kohn D,et al.Hydronephrosis following ureteral reimplantation:when is it concerning?[J].J Pediatr Urol,2012,8(5):481-487.DOI:10.1016/j.jpurol.2011.10.017.
23 Nelson CP,Hubert KC,Kokorowski PJ,et al.Long-term incidence of urinary tract infection after ureteral reimplantation for primary vesicoureteral reflux[J].J Pediatr Urol,2013,9(1):92-98.DOI:10.1016/j.jpurol.2011.12.009.
24 Wheeler D,Vimalachandra D,Hodson EM,et al.Antibiotics and surgery for vesicoureteric reflux:a meta-analysis of randomised controlled trials[J].Arch Dis Child 2003,88(8):688-694.DOI:10.1136/adc.88.8.688.
25 Elder JS,Diaz M,Caldamone AA,et al.Endoscopic therapy for vesicoureteral reflux:a meta-analysis.I.Reflux resolution and urinary tract infection[J].J Urol,2006,175(2):716-722.DOI:10.1016/S0022-5347(05)00210-7
26 Arlen AM,Scherz HC,Filimon E,et al.Is routine voiding cystourethrogram necessary following double hit for primary vesicoureteral reflux?[J].J Pediatr Urol,2015,11(1):40.e41-40.e45.DOI:10.1016/j.jpurol.2014.11.011.
27 European Society for Paediatric Urology. Do the type of bulking agents and injection method have any influence on the incidence of ureteral obstruction by endoscopic treatment of reflux?[EB/OL].[2019-10-10].https://www.espu.org/members/previous-events-abstracts.
28 Chertin B,Mele E,Kocherov S,et al.What are the predictive factors leading to ureteral obstruction following endoscopic correction of VUR in the pediatric population?[J].J Pediatr Urol,2018,14(6):538.e1-538.e7.DOI:10.1016/j.jpurol.2018.04.021.
29 Chung JM,Park CS,Lee SD.Postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux[J].Korean J Urol,2015,56(7):533-539.DOI:10.4111/kju.2015.56.7.533.
30 Friedmacher F,Puri P.Ureteral obstruction after endoscopic treatment of vesicoureteral reflux:does the type of injected bulking agent matter?[J].Curr Urol Rep,2019,20(9):49.DOI:10.1007/s11934-019-0913-5.
31 Okawada M,Murakami H,Tanaka N,et al.Incidence of ureterovesical obstruction and Cohen antireflux surgery after Deflux (R) treatment for vesicoureteric reflux[J].J Pediatr Surg,2018,53(2):310-312.DOI:10.1016/j.jpedsurg.2017.11.027.
32 Friedlander DA,Ludwig WW,Jayman JR,et al.The effect of prior endoscopic correction of vesicoureteral reflux on open ureteral reimplantation:Surgical outcomes and costs[J].J Pediatr Urol,2018,14(3):268.e1-268.e5.DOI:10.1016/j.jpurol.2018.01.023.
33 Garcia-Aparicio L,Rovira J,Blazquez-Gomez E,et al.Randomized clinical trial comparing endoscopic treatment with dextranomer hyaluronic acid copolymer and Cohen’s ureteral reimplantation for vesicoureteral reflux:long-term results[J].J Pediatr Urol,2013,9(4):483-487.10.1016/j.jpurol.2013.03.003.
34 Keren R,Shaikh N,Pohl H,et al.Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring[J].Pediatrics,2015,136(1):e13-e21.DOI:10.1542/peds.2015-0409.
35 Ehrlich RM,Gershman A,Fuchs G.Laparoscopic vesicoureteroplasty in children:initial case reports[J].Urology,1994,43(2):255-261.DOI:10.1016/0090-4295(94)90058-2.
36 Soulier V,Scalabre AL,Lopez M,et al.Laparoscopic vesico-ureteral reimplantation with Lich-Gregoir approach in children:medium term results of 159 renal units in 117 children[J].World J Urol,2017,35(11):1791-1798.DOI:10.1007/s00345-017-2064-y.
37 Kutikov A,Guzzo TJ,Canter DJ,et al.Initial experience with laparoscopic transvesical ureteral reimplantation at the Children’s Hospital of Philadelphia[J].J Urol,2006,176(5):2222-2225;discussion 2225-2226.DOI:10.1016/j.juro.2006.07.082
38 Tae BS,Choi H,Park JY,et al.Laparoscopic Approach for Intravesical Surgery Using Pneumovesicum in Urology:Literature Review[J].Int Neurourol J,2018,22(Suppl 1):S10-S22.DOI:10.5213/inj.1836022.011.
39 Javali T,Pathade A,Nagaraj HK.Laparoscopic extravesical detrusorraphy,a minimally invasive treatment option for vesicoureteral reflux:a single centre experience[J].J Pediatr Urol,2015,11(2):88.e1-e6.DOI:10.1016/j.jpurol.2015.01.007.
40 Gander R,Asensio M,Royo GF,et al.Laparoscopic Extravesical Ureteral Reimplantation for Correction of Primary and Secondary Megaureters:Preliminary Report of a New Simplified Technique[J].J Pediatr Surg,2019, pii:s0022-3468(19)30452-x.DOI:1016/j.jpedsurg.2019.05.028.
41 Boysen WR,Akhavan A,Ko J,et al.Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV):Outcomes and complications[J].J Pediatr Urol,2018,14(3):262.e1-262.e6.DOI:10.1016/j.jpurol.2018.01.020.
42 Deng T,Liu B,Luo L,et al.Robot-assisted laparoscopic versus open ureteral reimplantation for pediatric vesicoureteral reflux:a systematic review and meta-analysis[J].World J Urol,2018,36(5):819-828.DOI:10.1007/s00345-018-2194-x.
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备注/Memo
收稿日期:2019-09-09。
基金项目:北京市医院管理局"登峰"人才培养计划基金资助项目（编号：DFL20151102）；北京市医院管理局儿科协同发展专项子课题（编号：XTZD20180303）；北京市医院管理局"扬帆计划"小儿泌尿外科（编号：ZYLX201709）；北京市自然基金（7172073）
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