Study of Vesicoureteral Reflux (VUR) in Children

1)对14例原发输尿管返流患儿进行了尿动力学检查和肾核素肾显像检查。年龄4个月~10岁，平均4.2岁。双侧8例，单侧6例。VUR严重程度III级及以下者8例，IV级及以上者6例。年龄>3岁者(A组)7例，排尿压明显升高至82cmH2O，其中3例年龄较小者排尿压为57cmH2O。B组膀胱不稳定发生率为57%，而A组膀胱不稳定发生率为57%。肾瘢痕形成、排尿压力和/或VUR的严重程度之间无相关性。膀胱内高压，无论是在排尿时或收缩不稳定时，似乎与VUR的发生和加重有关。2)研究了球部尿道(环状)狭窄(即Cobb环状)与VUR的相关性。在过去的5年里，74名男孩(平均年龄5岁)被发现患有这种皮损。54%的人出现发热性尿路感染，并注意到有输尿管返流。尿失禁(日间和/或遗尿)和血尿也被记录下来。球部凹陷是X线片的特征，而所有这些都是通过内窥镜和婴儿膀胱镜确诊的。89%的患者出现了膀胱不稳定。经尿道切开(TUI)有效地控制了93%以上的并发症、输尿管返流和不稳定。在评估年轻男孩的VUR时，应注意先天性尿路狭窄(柯布氏领口)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.