神经源性膀胱伴输尿管反流的尿动力学研究

目的 探讨有输尿管反流的神经源性膀胱(NB)患儿有或没有逼尿肌过度活动(DO)时的尿动力学差异,为临床治疗此类患儿提供理论参考依据.方法 选取2013～2015年就诊并经影像尿动力学检查发现膀胱输尿管反流的NB患儿68例,男30例,女38例,年龄4～12岁,平均7.5岁.按照充盈期有DO,将其分为DO组(n=20)与无DO组(n=48).观察记录两组发生膀胱输尿管反流时的膀胱灌注量、逼尿肌压并计算发生反流时的膀胱顺应性;记录两组充盈结束时最大膀胱测压容量、最大逼尿肌压、并计算充盈期膀胱顺应性.结果 DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(98.7±16.1)ml和(5.2±1.9) ml/cmH2O,无DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(127.3±36.3)ml,(7.1±2.1)ml/cmH2O,差异均有统计学意义(P＜0.05);两组的逼尿肌压分别为(21.6±9.2)cmH2O、(19.2±7.4)cmH2O,差异没有统计学意义;DO组充盈结束时的膀胱容量与顺应性分别为(182.7±31.2)ml、(5.4±1.7) ml/cmH2O,与无DO组充盈结束时的膀胱容量(230.6±34.6)ml与顺应性(6.5±1.1)ml/cmH2O相比,差异有统计学意义;两组尿动力学检查结束时逼尿肌压分别为(33.8±7.8)cmH2O、(36.4±8.1)cmH2O,差异没有统计学意义.结论 膀胱容量小,膀胱顺应性差是有输尿管反流的NB患儿伴发DO时的尿动力学特征.     

影像尿动力学评估先天性膀胱输尿管返流患儿的膀胱功能障碍

目的 采用影像尿动力学评估小儿先天性膀胱输尿管返流(VUR)与膀胱功能障碍的关系.方法 选取2011年4月至2013年7月在郑州大学第一附属医院就诊的67例VUR患儿为研究对象.患儿经影像尿动力学、尿常规、排泄性尿路造影等检查,记录患儿尿路感染、逼尿肌过度活动、逼尿肌括约肌协同失调及VUR程度等情况,根据尿动力学表现的不同分为正常组、单纯逼尿肌过度活动组和逼尿肌括约肌协同失调组(伴或不伴逼尿肌过度活动的逼尿肌括约肌协同失调),另外按照返流级别将患儿分为低级别返流(Ⅰ～Ⅱ度)和高级别返流(Ⅲ～Ⅴ度),分析膀胱功能与VUR侧别、返流程度以及尿路感染的关系.结果 VUR患儿合并膀胱功能异常占73.1％(49/67例),其中膀胱过度活动症占49.3％(33/49例),逼尿肌括约肌协同失调占23.8％(16/49例).单纯膀胱过度活动患儿多为单侧,Ⅰ～Ⅱ度返流,且较少合并尿路感染.而逼尿肌括约肌协同失调的患儿多为双侧,Ⅲ～Ⅳ度返流,且较多见尿路感染.结论 影像尿动力学可以准确诊断VUR,同时对患儿膀胱功能的评估,及临床制定治疗方案提供重要参考.     

小儿膀胱输尿管反流无辐射诊断技术的研究进展

儿童膀胱输尿管反流(VUR)既往初步诊断是采用放射性排泄性膀胱尿道造影术(VCUG)、放射性核素膀胱造影术等方法，但这些方法有辐射暴露或缺乏空间分辨率的缺点。该文对不同方法进行回顾，并介绍无辐射的排泄性尿道超声检查(VUS)。应用VUS对女孩和反流高危人群进行筛查，使VCUG检查的数量能够减少一半以上，从而也使儿童的辐射暴露有明显的减少。伴随谐波超声成像的出现，超声反流检查将会获得进一步的诊断潜力和广泛的应用。     

小儿膀胱输尿管反流无辐射诊断技术的研究进展

儿童膀胱输尿管反流(VUR)既往初步诊断是采用放射性排泄性膀胱尿道造影术(VCUG)、放射性核素膀胱造影术等方法,但这些方法有辐射暴露或缺乏空间分辨率的缺点。该文对不同方法进行回顾,并介绍无辐射的排泄性尿道超声检查(VUS)。应用VUS对女孩和反流高危人群进行筛查,使VCUG检查的数量能够减少一半以上,从而也使儿童的辐射暴露有明显的减少。伴随谐波超声成像的出现,超声反流检查将会获得进一步的诊断潜力和广泛的应用。     

膀胱输尿管反流的诊疗争议和研究进展

小儿原发性膀胱输尿管反流(vesicoureteric reflux,VUR)与尿路感染、排尿功能障碍相伴发生,常常导致肾疤痕、肾萎缩、高血压、肾功能减退等一系列反流性肾病的表现,重者甚至进展为终末期肾病.目前,随着对VUR治疗经验的累积,在诊断策略及治疗上都出现了一定的争议.无论手术治疗或非手术治疗结果仍不令人满意,VUR的发病机制目前还不清楚,需要进行进一步的研究和探索.     

小儿原发性膀胱输尿管反流及其肾病的研究进展

小儿原发性膀胱输尿管反流 (vesicouretericreflux ,VUR)与尿路感染、排尿功能障碍相伴发生常常导致肾疤痕、肾萎缩、高血压、肾功能减退等一系列反流性肾病的表现 ,重者甚至进展为终末期肾病。目前 ,从尿流动力学、血流动力学、感染、免疫及遗传学等多领域探索VUR及反流性肾病的发病机制。VUR的诊断技术在影像、生化、尿流动力学等多领域有很大进展 ,提高了对反流及肾损害的评价敏感性。小儿原发性VUR需要及早诊断 ,同时对肾损害做出充分的预测 ,建立个体化的有效的治疗方案     

小儿膀胱输尿管返流的诊治进展

小儿膀胱输尿管返流（ＶＵＲ）及反流性肾病的病因、病理生理、影像学检查及治疗等方面的研究，近几年有很大进展，但某些方面仍存有争论，有些地方还难以理解，有待深入研究。一、病因小儿ＶＵＲ的病因，已不再认为是单一的输尿管口位置异常的病理过程。反流有种族差异和...     

儿童尿路感染与膀胱输尿管反流的诊断与干预

尿路感染(urinary tract infections,UTI)是儿童最常见的急性细菌性感染之一,其在儿童中的确切发病率由于受到标本采集方法及诊断标准的影响而尚未明确.     

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CSCD

Objective To evaluate the lower urinary tract dysfunction （ LUTD） in children with vesicoureteral reflux（ VUR）without neurological or lower urinary tract organic lesions by urodynamic examination. Methods From January 2017 to December 2021, the results of UDS examination were retrospectively reviewed for 106 VUR children. According to the presence or absence of LUTD, they were divided into LUTD group（ n =77） and non-LUTD group （ n =29）. Such urodynamic parameters as bladder volume, residual urine volume （ PVR） and maximum urine flow rate were compared between two groups. Results Residual urine volume was significantly higher in LUTD group than that in non-LUTD group（ t =5. 564, P = 0. 008）. And maximum urine flow rate was lower than that in non-LUTD group （ t = 6. 314, P = 0. 030）. Among LUTD children, 29 cases were of low grade VUR（ grades I 一 如）and 48 cases high grade VUR （ grades W - V）. Bladder compliance （ χ2 = 7. 537, P = 0. 006）and PVR（ χ2 = 4. 298, P = 0. 038）were significantly different between low-grade VUR and highgrade VUR. Idiopathic detrusor overactivity disorder（ IDOD）was the more common type of LUTD 45. 5%（35/77）and 65.5%（19/29）in low-grade VUR. Dysfunctional voiding（ DV）was more common in high-grade VUR 56.2%（27/48）. Conclusion Higher PVR and lower maximum urine flow rate hint at a greater possibility of LUTD in VUR children. Children with high-grade VUR are more likely to have a greater increase in PVR and a poor bladder compliance. IDOD is common in low-level VUR while DV is more common in high-level VUR. © 2023, Science and Technology Association of Hunan Province. All rights reserved.     

机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流

目的探讨机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流的可行性、安全性和手术技巧。方法回顾性分析2014年5月至2019年2月上海市儿童医院收治的11例原发性膀胱输尿管反流患儿临床资料,其中男童10例,女童1例,均应用达芬奇系统辅助腹腔镜行Lich-Greqoir输尿管再植手术。患儿平均年龄9.4岁(3.2~18岁)。其中双侧4例,单侧7例。反流程度Ⅱ~Ⅳ级(Ⅱ级2侧,Ⅲ级3侧,Ⅳ级10侧)。结果患儿均采用Lich-Gregoir术式,术中患侧输尿管平均直径9 mm(5~15 mm),平均黏膜下隧道长度4.4 cm(3~6 cm)。术中无中转开放手术,单侧输尿管手术平均时间152 min(132~175 min),双侧输尿管手术平均时间257 min(249~264 min),术后平均住院时间4.5 d(3~6 d),1例双侧VUR患儿术后出现短期尿潴留,延长留置导尿管2周后痊愈。患儿平均随访时间2.5年(6个月至5.3年),所有病例均无发热性尿路感染,B超均未见患侧输尿管肾盂积水加重。术后完成VCUG 9例(其中双侧4例,单侧5例),其中1例双侧病例术后发现左侧反流Ⅰ级。结论机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流安全、有效,可以应用于3岁以上儿童的治疗。     

排尿性尿路超声造影对儿童原发性膀胱输尿管反流的诊断价值

目的 探讨排尿性尿路超声造影(contrast-enhanced voiding urosonography,CeVUS)对儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)的诊断价值.方法 回顾性分析上海儿童医学中心2018年12月至2020年6月116例[232个肾盂-输尿管单位(pye...     

Endoscopic treatment of vesicoureteral reflux with collagen

Submucosal injection of bovine collagen (Zyplast) was performed in 1 boy, 41 girls, and 9 women with 79 refluxing ureters. Five ureters had grade IV reflux, while the others had grades I–III. All patients suffered from recurrent urinary tract infections. In 25 ureters a second injection was given. As a result of this treatment, reflux is absent in 86% of the ureters. Only 15 patients had urinary tract infections during the follow-up period (6–30 months). Collagen injections could gain great importance in the management of vesicoureteral reflux.     

Primary vesicoureteral reflux in infants with a dilated fetal urinary tract

Vesicoureteral reflux (VUR) was recognized neonatally by voiding cystography in 25 of 117 infants with a dilated fetal urinary tract. There was a male preponderance (76%) and a high percentage (40%) of associated urinary malformations. Thirtynine refluxing units were studied. All grades of VUR were detected but gross dilating VUR dominated (59%). Spontaneous resolution was excellent in lower grades of VUR but was poor in gross VUR. Surgery was successfully performed in 13 renal units of nine patients with gross reflux [8], additional ipsilateral malformations [4], or pyelonephritis during antibiotic prophylaxis [1]. Segmental renal scars developed in four kidneys after urinary infections, and a diffuse parenchymal lesion was noted in nine kidneys even at birth. One boy with duplication had a non-functioning refluxing system. Our results in a small number of infants show differences to children with VUR detected after urinary infections and seem to support the existence of a congenital reflux nephropathy.     

Occurrence of vesicoureteral reflux in children

Aim: The reported low occurrence of vesicoureteral reflux in the general population seems implausible. We wanted to test the hypothesis that reflux is more common and more independent of urinary‐tract infection than has previously been thought. Methods: We tested our hypothesis by analysing the characteristics of 406 consecutive children aged <5 years who had been referred for consultation because of urinary‐tract infection. Using data on their urine samples, we evaluated the reliability of the urinary‐tract infection diagnosis and analysed the frequencies of vesicoureteral reflux and abnormal ultrasound findings in three reliability groups (A: certain urinary‐tract infection, B: possible and C: improbable). Results: The occurrence of reflux was the same irrespective of the diagnostic reliability of urinary‐tract infection (A: 98/276 [36%] versus B: 13/46 [28%] versus C: 9/25 [36%]). Most of the abnormal ultrasound findings (58/71, 80%) were found among patients with a certain diagnosis (Group A). Conclusion: We suggest that vesicoureteral reflux is more common in children even without urinary‐tract infection than has been thought previously. The guidelines recommending a search for reflux by means of voiding cystourethrography should be reconsidered.     

腹腔镜气膀胱Cohen输尿管移植术及开放手术在婴幼儿巨输尿管治疗中的对比研究

目的通过对比研究,总结腹腔镜气膀胱Cohen输尿管移植术治疗婴幼儿巨输尿管的疗效和手术经验。方法作者于2008年1月至2012年6月采用Cohen输尿管移植术治疗年龄〈3岁的婴幼儿巨输尿管24例,其中经腹腔镜气膀胱治疗11例（双侧3例,单侧8例）,为气膀胱手术组;同期开放手术治疗13例（双侧2例,单侧11例）,为开放手术组。将两组患儿手术年龄、手术时间、失血量、住院时间、并发症及远期效果进行比较。结果经腹腔镜气膀胱行Cohen输尿管移植术成功10例,1例中转开腹手术（合并脊髓拴系综合征,麻醉后期出现膀胱痉挛）,平均手术时间为（132．6±34．7）min,与开放手术时间[（129．7±37．2）min]相当（P〉0．05）;平均手术失血量（3．8±1．4）mL,少于开放手术组[15．4±3．7）mL]（P〈0．05）;术后平均住院时间（6．9±1．4）d,小于开放手术组[（11．3±2．6）d]（P〈0．05）。开放手术组患儿术后切口感染1例,尿外渗2例,气膀胱手术组患儿术后无明显并发症,远期随访输尿管通畅,无反流,与开放手术远期效果一致。结论年龄小于3岁的婴幼儿巨输尿管患者,经腹腔镜气膀胱行Cohen输尿管移植术是一种安全有效的治疗方式。     

儿童原发性膀胱输尿管反流管理

膀胱输尿管反流(Vesicoureteral Reflux,VuR)是由于膀胱输尿管连接部瓣膜作用不全以致尿液自膀胱反流入输尿管、肾盂的疾病。小儿的膀胱输尿管反流多与先天发育异常及泌尿系畸形有关。由于膀胱输尿管反流的存在,常常引起小儿反复的泌尿系感染,感染的尿液反流入肾组织引起肾实质损害,可导致肾脏发育延迟、肾瘢痕形成,引起反流性肾病,最终导致成人后发生高血压和终末期肾脏病(end-slage