Contemporary Management of Vesicoureteral Reflux.
Contemporary Management of Vesicoureteral Reflux.
复制标题
膀胱输尿管反流的当代治疗。
DOI：
10.1007/s40746-016-0045-9
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发表时间：
2016
影响因子：
--
通讯作者：
Hains,DavidS
中科院分区：
文献类型：
--
作者：
Johnston,DerrickL;Qureshi,AslamH;Irvine,RhysW;Giel,DanaW;Hains,DavidS
意见陈述过去 30 年，膀胱输尿管反流 (VUR) 的诊断和治疗发生了广泛的变化。最近，一场临床争论在学术界引起了公开讨论。新的证据已经改变了治疗模式，不再广泛采用手术治疗，并且最近对一些药物治疗提出了质疑。 VUR 本身通常没有危险，但它是尿路感染 (UTI) 以及不太常见的肾疤痕和功能不全的重要危险因素。考虑到尿路感染的成本和发病率以及严重肾损伤的可能性，我们的方法仍然保守。仔细的随访、家长关于 VUR 和 UTI 的病理生理学和治疗的教育以及肠和膀胱功能障碍 (BBD) 的治疗（如果存在）是治疗的基础。此外，尽管我们认识到持续抗生素预防 (CAP) 的局限性，但我们相信对于许多患者来说，其益处大于风险和成本。对于有单一医疗之家、父母了解 UTI 体征和症状、低级别 VUR、无复杂 UTI 病史并密切随访的患者，可以考虑仔细观察。对于保守治疗失败、尿路感染突破或无法解决的特定患者来说，手术治疗仍然是一个相关选择。尽管开放式输尿管膀胱造口术仍然具有最高的成功率，但微创手术的选择是可以接受的。
Opinion statementThe past 30 years have seen broad changes in the diagnosis and management of vesicoureteral reflux (VUR). Recently, a clinical debate has generated an open discussion in academic circles. New evidence has shifted treatment patterns away from widespread surgical management and recently brought into question some pharmacologic treatments. VUR is usually not hazardous by itself but is a significant risk factor for urinary tract infection (UTI) and less commonly, renal scarring and insufficiency. Given the costs and morbidity of UTI as well as the potential for significant renal injury, our approach remains conservative. Careful follow-up, parental education about pathophysiology and management of VUR and UTI, and management of bowel and bladder dysfunction (BBD), when present, are the foundations of treatment. Additionally, though we recognize the limitation of continuous antibiotic prophylaxis (CAP), we believe that the benefits outweigh the risks and costs for many patients. Careful observation can be considered in patients with a single medical home, parental understanding of what UTI signs and symptoms are, low grade VUR, no history of complicated UTIs, and close follow-up. Surgical management remains a relevant option for select patients who fail conservative measures with breakthrough UTIs or failure to resolve. Minimally invasive surgical options are available with acceptable outcomes though open ureteroneocystostomy still carries the highest success rate.