Study of Vesicoureteral Reflux (VUR) in Children

1)对14例原发性VUR患儿进行尿动力学研究和肾显像评价。年龄从4个月到10岁不等，平均4.2岁。8例双侧，6例单侧。8例患者的VUR严重程度为III级及以下，6例患者的VUR严重程度为IV级及以上。A组7例3岁以上患者排尿压力为82 cm H_2O， 3例3岁以下患者排尿压力为57 cm H_2O。B组没有发现膀胱不稳定，而a组有57%的患者有膀胱不稳定。肾瘢痕、排尿压力和/或VUR严重程度之间没有相关性。高膀胱内压力，无论是排尿时还是不稳定收缩时，似乎都与VUR的发生和加重有关。2)研究了尿道球部（环状）狭窄（即Cobb颈圈）与VUR的相关性。在过去的5年中，有74名男孩（平均年龄5岁）被发现有这种病变。54%的患者表现为发热性尿路感染，并被记录为VUR。尿失禁（昼尿和/或遗尿）和血尿也被注意到。球囊压痕为x线表现，所有病例均经婴儿膀胱尿道镜检查证实。膀胱不稳定发生率为89%。经尿道切开（TUI）可有效控制症状、VUR和不稳定，超过93%。在评估年轻男孩的VUR时，应注意先天性尿道狭窄（柯布颈圈）的存在。

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.