| 摘要 |
Vesicoureteral reflux (VUR) is a common disorder in children. It occurs in 1-2% of
infants and children. VUR may disappear spontaneously in some children, while
renal failure may develop in others. VUR is sometime associated with immature
bladder function. Genetic involvements of the disease are observed but the exact
genes involved are still unclear. It accounts for more than 40% of childhood urinary
tract infections (UTI) and is found in 17-37% of cases of prenatally diagnosed
hydronephrosis. Ultrasonography is not an ideal diagnostic tool but postnatal
calicectasis is an important predictor of VUR. Renal ultrasonography and Tc99-
dimercaptosuccinic acid renal scanning (DMSA) should be sufficient in evaluating
children with first febrile UTI. Voiding cystourethrography (VCUG) is indicated
when there are apparent abnormalities on either ultrasonography or DMSA
scanning or both. Screening is recommended for all siblings, who are younger than 3
years old, of index patients with grades III to V vesicoureteral reflux. Recurrent
febrile urinary tract infections, bilateral abnormalities and reduced total glomerular
filtration rates are predisposing factors of renal injury. Prompt treatment of UTI
may reduce renal scars. The effectiveness of prophylactic antibiotics is controversial.
Cephalosporins are not appropriate for prophylaxis. Bilateral reflux, high grade
reflux and an abnormal DMSA scan have a higher chance of breakthrough infection.
Patients aged less than 1 year at presentation, with a lower reflux grade, and single
ureter involvement tend to have earlier resolution of reflux. Successful endoscopic
correction using dextranomer/hyaluronic acid injection helps to reduce the
development of new renal scarring and the incidence of febrile UTI. Open or
laparoscopic surgery is preferred in high grade VUR. |
