Study of Vesicoureteral Reflux (VUR) in Children

1)本文对14例原发性膀胱输尿管返流患儿进行了尿动力学检查和肾动脉造影。年龄4个月~ 10岁，平均4.2岁。8例为双边，6例为单边。VUR严重程度为III级或以下8例，IV级或以上6例。3岁以上组（A组）7例排尿压力明显高于正常组（82 cm H_2O），3岁以下组（B组）3例排尿压力明显高于正常组（57 cm H_2O）。B组无膀胱不稳发生，而A组发生率为57%.肾瘢痕形成、排尿压力和/或VUR严重程度之间无相关性。高膀胱内压，无论是在排尿或不稳定的收缩，似乎是相关的VUR的发生和加重。2）相关性的球尿道（环状）狭窄（即Cobb的衣领），VUR进行了研究。在过去的5年中，74名男孩（平均年龄5岁）被发现有病变。54%的患者出现发热性尿路感染，并注意到有VUR。还观察到尿失禁（日间和/或遗尿）和血尿。球压痕是X线特征，而所有的婴儿膀胱尿道镜内镜证实。膀胱不稳定是注意到在89%.Transurethral切口（TUI）是有效的控制目前的疾病，VUR和不稳定超过93%.In评估VUR在年轻的男孩先天性尿道狭窄（Cobb的衣领）的存在是要提醒。

1) Urodynamic study and renal scintigraphic evaluation were done on 14 boys with primary VUR. Their ages ranged 4 months to 10 years with an average 4.2 years. 8 were bilateral and 6 unilateral. Severity of VUR were grade III or less in 8 patients and grade IV or more in 6. Voiding pressure was apparently high of 82 cm H_2O in those (7 patients) older than 3 years old (group A) while it was 57 cm H_2O in 3 patients younger. Bladder instability was not found in group B while it was noted in 57 % of group A. There was no correlation among the renal scarring, voiding pressure and/or severity of VUR. High intravesical pressure, be it during voiding or with unstable contraction, appears to be relevant in the genesis and aggravation of VUR.2) Relevance of bulbar urethral (ring-like) stricture (i.e. Cobb's collar) to VUR was studied. In the past 5 years 74 boys (average age 5 years old) were noted to have the lesion. 54 per cent presented with febrile urinary infection and noted to have VUR. Urinary incontinence (diurnal and/or enuresis) and hematuria were also noted. Bulbar indentation was the roentgenographic feature, while all were confirmed endoscopically with infant cystourethroscope. Bladder instability was noted in 89 per cent. Transurethral incision (TUI) was effective in controlling presenting illnesses, VUR and instability over 93 per cent. In evaluating VUR in young boys the presence of congenital urethral stricture (Cobb's collar) is to be reminded.