Zhang Gaofeng,Wang Yuxiang,Li Zhijuan,et al.Establishment of diagnostic system and treatment outcome for urethrovaginal reflux in girls[J].Journal of Clinical Pediatric Surgery,2026,(09):872-876.[doi:10.3760/cma.j.cn101785-20260325-00133]
女童尿道阴道反流的诊断体系建立与治疗转归
- Title:
- Establishment of diagnostic system and treatment outcome for urethrovaginal reflux in girls
- Keywords:
- Urinary Incontinence; Children; Urethrovaginal Reflux; Bladder Diary
- 摘要:
- 目的 探讨女童尿道阴道反流（urethrovaginal reflux,UVR）的临床特点，提高儿科医师对UVR 的认识。方法 本研究为回顾性病例系列研究，收集西安交通大学附属儿童医院2021年1月至2026年1月收治的4例UVR患儿的临床资料，同时检索PubMed、万方数据库、中国知网、维普数据库截至2026年3月收录的女童UVR相关文献，就其临床表现、诊断方法、治疗方案及预后情况展开分析。结果 通过文献检索，共纳入17篇女童UVR病例报告研究，涉及52例，结合本院4例病例，共56例女童UVR。就诊年龄为3~16岁。49例主诉为尿失禁，其中合并尿路感染12例；其余7例主诉为尿路感染2例，盆腔疼痛或腰痛2例、阴道炎1例、排尿困难伴阴道炎1例、性早熟1例。其中26例采用排尿日记联合泌尿系彩超确诊UVR，采用膀胱尿道造影确诊UVR 27例，采用静脉肾盂造影及泌尿系增强CT、磁共振确诊3例。我院4例中3例为青春期前患儿，主诉均以尿失禁为主，3例合并肥胖，3例合并便秘，2例合并尿路感染，2例存在膀胱过度活动，1例合并夜间遗尿。排尿日记特点均表现为自然如厕排尿后10分钟内漏尿。膀胱造影特点为排尿时阴道积液，二次排尿后阴道积液消失。治疗方面，采用尿道阴道反流排尿训练联合泌尿疗法治疗24例；在此基础上联合抗胆碱、减重、纠正便秘等治疗32例。2例合并膀胱过度活动症及残余尿量增多的患儿治疗无效，1例治疗缓解后因依从性差出现复发，其余患儿均治疗有效。结论 尿道阴道反流多见于青春期前女孩，排尿日记特点为自然如厕排尿后10分钟内漏尿，下次自然排尿前多数时间不伴漏尿，膀胱造影特点为排尿时阴道积液，二次排尿后阴道积液消失。符合前述特点的排尿日记和膀胱造影的青春期前后女童可诊断UVR。尿道阴道反流的排尿姿势训练和泌尿疗法是核心治疗，治疗效果与患方依从性及共病的治疗有很大关系，多数患儿治疗效果良好。对于治疗效果不佳的患儿可行尿动力学检查等进一步评估，从而制定个体化的治疗方案。
- Abstract:
- Objective To explore the clinical features of urethrovaginal reflux (UVR) in girls and improve pediatricians’ recognition of this disease.Methods Retrospective review was performed for the relevant clinical data of 4 UVR girls from January 2021 to January 2026.And the public databases of PubMed,Wanfang Database,CNKI and VIP were searched for literature items on UVR in girls published up to March 2026.Clinical presentations,diagnostic approaches,treatment strategies and prognostic outcomes were examined.Results Our literature review identified 17 case reports involving 52 UVR girls.Four cases were selected from our hospital.A total of 56 girls had an age range of 3 to 16 years.There was urinary incontinence (n=49) with concurrent urinary tract infection (UTI,n=12).The remainders presented primarily with UTI (n=2),pelvic or low back pain (n=2),vaginitis (n=1),dysuria with vaginitis (n=1) or precocious puberty (n=1).A definite diagnosis was made by voiding diaries combine with urinary tract color Doppler ultrasound (n=26),cystourethrography (n=27) and intravenous pyelography with enhanced urinary tract computed tomography (CT) or magnetic resonance imaging (MRI)(n=3).In our cohort,3 prepubertal girls presented chiefly with urinary incontinence with such comorbidities as obesity (n=3),constipation (n=3),UTI (n=2),overactive bladder (n=2) and nocturnal enuresis (n=1).Voiding diaries consistently demonstrated urine leakage within 10 min after spontaneous voiding.Cystography indicated that vaginal fluid accumulation during voiding resolved upon secondary voiding.Treatment consisted of UVR-specific voiding training combine with urological interventions (n=24).Another 32 cases received additional therapies such as anticholinergics,weight management and constipation relief.Treatment was ineffective in 2 cases with both overactive bladder and elevated residual urine volume.One child relapsed due to poor compliance after initial remission.The remainders responded effectively to treatment.Conclusions UVR predominantly affects prepubertal girls.Characteristic voiding diary findings include urine leakage within 10 min after spontaneous voiding with minimal or no leakage in intervals preceding the next void.Cystography typically reveals vaginal fluid accumulation during voiding and clearing after a secondary void.Girls around puberty exhibiting hallmark voiding diary and cystographic features are definitely diagnosed as UVR.The cornerstone of management involves UVR-specific voiding posture training and urological therapy.The clinical outcomes are strongly influenced by patient adherence and a proper management of comorbid conditions,generally resulting in favorable results.For those with inadequate response,further assessments of urodynamic studies are advised to tailor individualized treatment protocols.
参考文献/References:
[1] 胡丽丽，王春祥，孙焱，等.儿童尿道阴道反流导致非梗阻性阴道积液1例[J].实用放射学杂志，2025,41(9):1587-1588.DOI:10.3969/j.issn.1002-1671.2025.09.040.Hu LL,Wang CX,Sun Y,et al.Urethrovaginal reflux presenting as transient urocolpos in children:one case report[J].J Pract Radiol,2025,41(9):1587-1588.DOI:10.3969/j.issn.1002-1671.2025.09.040.
[2] Chatur C,Balani A,Rao RP,et al.Non obstructive hydrocolpos due to vesicovaginal reflux in an adolescent female[J].Indian J Nephrol,2020,30(5):348-349.DOI:10.4103/ijn.IJN_413_19.
[3] Prabhuswamy VK,Krishnamoorthy V,Matippa P.Pediatric urethrovaginal reflux:an underestimated cause of urinary incontinence and its successful management[J].Int Urogynecol J,2023,34(12):3013-3021.DOI:10.1007/s00192-023-05650-x.
[4] Arora S,Solanki AB,Singh D,et al.Vesicovaginal reflux:a masquerader[J].J Clin Ultrasound,2025,53(4):904-908.DOI:10.1002/jcu.23907.
[5] 马晨，王春祥，胡丽丽，等.儿童膀胱阴道反流1例[J].中国临床医学影像杂志，2023,34(10):757-758.DOI:10.12117/jccmi.2023.10.022.Ma C,Wang CX,Hu LL,et al.Vesicovaginal reflux in children:one case report[J].J Chin Clin Med Imaging,2023,34(10):757-758.DOI:10.12117/jccmi.2023.10.022.
[6] 徐魏军，胡丽丽，吴勇，等.儿童膀胱阴道反流的超声诊断价值[J].中国超声医学杂志，2025,41(8):949-951.DOI:10.3969/j.issn.1002-0101.2025.08.029.Xu WJ,Hu LL,Wu Y,et al.Diagnostic value of ultrasound in children with vesicovaginal reflux[J].Chin J Ultrasound Med,2025,41(8):949-951.DOI:10.3969/j.issn.1002-0101.2025.08.029.
[7] 中华医学会小儿外科学分会小儿尿动力和盆底学组.儿童尿失禁临床诊治中国专家共识（2024年版）[J].临床小儿外科杂志，2024,23(3):201-209.DOI:10.3760/cma.j.cn101785-202302006-001.Group of Pediatric Urodynamics & Pelvic Floor,Branch of Pediatric Surgery,Chinese Medical Association.Chinese Expert Consensus on Clinical Diagnosis and Treatment of Urinary Incontinence in Children (Edition 2024)[J].J Clin Ped Sur,2024,23(3):201-209.DOI:10.3760/cma.j.cn101785-202302006-0 01.
[8] Rakowska-Silska M,Jobs K,Paturej A,et al.Voiding disorders in pediatrician’s practice[J].Clin Med Insights Pediatr,2020,14:1179556520975035.DOI:10.1177/1179556520975035.
[9] Sakakura H,Shono K,Hashimoto Y,et al.Infantile urethrovaginal reflux in three cases[J].Pediatr Int,2022,64(1):e14736.DOI:10.1111/ped.14736.
[10] 张艳，张艳平，张瑞莉，等.儿童非神经源性下尿路功能障碍的影像尿动力学和临床特征分析[J].中华医学杂志，2022,102(38):3001-3006.DOI:10.3760/cma.j.cn112137-202201 18-00129.Zhang Y,Zhang YP,Zhang RL,et al.Analysis of video-urodynamic and clinical features of non-neuropathic lower urinary tract dysfunction in children[J].Natl Med J China,2022,102(38):3001-3006.DOI:10.3760/cma.j.cn112137-20220118-00129.
相似文献/References:
[1]袁淼 黄桂珍 马俊梅 单伟 马丽 黄一东 马学 曾莉 黄鲁刚.膀胱颈折叠成形术治疗女童短尿道畸形所致尿失禁8例[J].临床小儿外科杂志,2013,12(01):61.
[2]花朝阳,汪玺正,马源,等.婴幼儿排尿训练对儿童排尿异常的影响调查分析[J].临床小儿外科杂志,2019,18(11):948.[doi:10.3969/j.issn.1671—6353.2019.11.010]
Hua Chaoyang,Wang Xizheng,Ma Yuan,et al.The survey analysis of voiding training in infants on the voiding dysfunction in children[J].Journal of Clinical Pediatric Surgery,2019,18(09):948.[doi:10.3969/j.issn.1671—6353.2019.11.010]
[3]张志博,李雪,康磊,等.女性“隐蔽性”尿道上裂治疗初探[J].临床小儿外科杂志,2020,19(11):1002.[doi:10.3969/j.issn.1671-6353.2020.11.008]
Zhang Zhibo,Li Xue,Kang Lei,et al.A primary study of female occult epispadias[J].Journal of Clinical Pediatric Surgery,2020,19(09):1002.[doi:10.3969/j.issn.1671-6353.2020.11.008]
[4]彭志炜,黄轶晨.典型膀胱外翻骨盆截骨手术前后盆底结构 变化研究进展[J].临床小儿外科杂志,2022,21(07):680.[doi:10.3760/cma.j.cn101785-202101011-016]
Peng Zhiwei,Huang Yichen.Research progress of pelvic floor structure changes before and after pelvic osteotomy for classic bladder exstrophy[J].Journal of Clinical Pediatric Surgery,2022,21(09):680.[doi:10.3760/cma.j.cn101785-202101011-016]
[5]王庆伟,文建国.重视尿动力检查,提高儿童尿失禁诊治水平[J].临床小儿外科杂志,2023,22(02):101.[doi:10.3760/cma.j.cn101785-202212007-001]
Wang Qingwei,Wen Jianguo.Focusing upon urodynamic testing for a better management of urinary incontinence in children[J].Journal of Clinical Pediatric Surgery,2023,22(09):101.[doi:10.3760/cma.j.cn101785-202212007-001]
[6]李宁,张潍平,田军,等.尿动力检查评估膀胱输尿管反流患儿下尿路功能障碍的临床研究[J].临床小儿外科杂志,2023,22(02):118.[doi:10.3760/cma.j.cn101785-202210064-004]
Li Ning,Zhang Weiping,Tian Jun,et al.Urodynamic evaluations of lower urinary tract dysfunction in children with vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2023,22(09):118.[doi:10.3760/cma.j.cn101785-202210064-004]
[7]中华医学会小儿外科学分会小儿尿动力和盆底学组.儿童尿失禁临床诊治中国专家共识(2024年版)[J].临床小儿外科杂志,2024,23(03):201.[doi:10.3760/cma.j.cn101785-202302006-001]
Group of Pediatric Urodynamics & Pelvic Floor,Branch of Pediatric Surgery,Chinese Medical Association.Chinese Expert Consensus on Clinical Diagnosis and Treatment of Urinary Incontinence in Children[J].Journal of Clinical Pediatric Surgery,2024,23(09):201.[doi:10.3760/cma.j.cn101785-202302006-001]
[8]汤梁峰,孙瑜博,王安乐,等.后尿道瓣膜症患儿术后尿失禁症状和尿动力、肾功能变化特征分析[J].临床小儿外科杂志,2026,(07):627.[doi:10.3760/cma.j.cn101785-20260408-00164]
Tang Liangfeng,Sun Yubo,Wang Anle,et al.Incontinence and changes in urodynamics and renal function in children with posterior urethral valves[J].Journal of Clinical Pediatric Surgery,2026,(09):627.[doi:10.3760/cma.j.cn101785-20260408-00164]
备注/Memo
收稿日期:2026-3-25。
基金项目:西安市科学技术局项目（24YXYJ0059）
通讯作者:白明,Email:573076087@qq.com