背景:双侧膀胱输尿管反流(VUR)与不良的长期预后有关,缺乏专门针对其对膀胱功能影响的研究。本研究旨在评估双侧VUR患儿的尿动力学特征,并确定影响肾功能的因素。
方法:对2019年1月至2023年1月在我院门诊接受尿动力学检查的双侧VUR患儿进行回顾性分析。所有患者均接受全面评估,包括排尿膀胱尿道造影,泌尿系统超声和尿动力学检查,分析与不同临床特征相关的尿动力学特征。
结果:该研究包括148名双侧VUR儿童,其中92人(62.2%)表现出尿动力学异常,其中特发性逼尿肌过度活动(DO)30例(20.3%),功能失调(DV)58例(39.2%)。DV在5岁以下的儿童中普遍存在,而特发性DO主要见于2岁以上的儿童.5岁以上的儿童表现出膀胱体积减少的趋势。而年龄小于2岁的患者通常膀胱体积和残余尿液增加。多因素分析确定双侧重度VUR是估计肾小球滤过率异常的独立危险因素。
结论:与年龄较大的儿童相比,在膀胱体积较大且残余尿量增加的年龄较小的儿童中,DV更常见。相比之下,年龄较大的儿童比年龄较小的儿童更容易受到膀胱体积较小的特发性DO的影响.双侧严重反流增加肾功能异常的可能性,这似乎是先天性疤痕的结果,而不是膀胱功能异常。
BACKGROUND: Bilateral vesicoureteral reflux (VUR) has been associated with poor long-term prognosis, and research focusing exclusively on its effect on urinary bladder function is lacking. This study aims to assess the urodynamic characteristics of children with bilateral VUR and identify factors influencing renal function.
METHODS: A retrospective analysis was performed on children diagnosed with bilateral VUR who underwent urodynamic examination in the outpatient department of our institution from January 2019 to January 2023. All patients underwent comprehensive assessments, including voiding cystourethrography, urinary system ultrasound and urodynamic examination, to analyse the urodynamic features associated with different clinical characteristics.
RESULTS: The study included 148 children with bilateral VUR, amongst whom 92 (62.2%) exhibited urodynamic abnormalities, including idiopathic detrusor overactivity (DO) in 30 cases (20.3%) and dysfunctional voiding (DV) in 58 cases (39.2%). DV was prevalent in children under 5 years of age, whereas idiopathic DO was predominantly observed in children older than 2 years of age. Children older than 5 years of age exhibited a trend towards reduced bladder volume, whereas those younger than 2 years of age often had increased bladder volume and residual urine. Multivariate analysis identified bilateral severe VUR as an independent risk factor for abnormal estimated glomerular filtration rate.
CONCLUSIONS: DV tends to be more common in younger children with larger bladder volumes and increased residual urine than in older children. By contrast, older children are more susceptible to idiopathic DO associated with smaller bladder volumes than younger children. Bilateral severe reflux increases the likelihood of renal functional abnormalities, which appear to be a consequence of congenital scarring rather than abnormalities in bladder function.