下泌尿道失調及膀胱輸尿管逆流是預測兒童復發性發燒型尿路感染的重要因子
林才揚1、蘇家震1、沈坤宏1、楊緒棣2、張尚仁2
1奇美醫學中心 外科部 泌尿科
2台北慈濟醫院 外科部 泌尿科
Lower urinary tract dysfunction with vesicoureteral reflux: a more significant factor predicting recurrent febrile uti in infants
Chye-Yang Lim1, Su Chia-Cheng1, Kun-Hung Shen1 , Shang-Jen Chang2 , Stephen S. Yang2
1Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
2Division of Urology, Taipei Tzu Chi Hospital, New Taipei, Taiwan and Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
Introduction:
Lower urinary tract dysfunction (LUTD) is a recognized risk factor of recurrent UTI. We examined the effects of LUTD alone and LUTD + vesicoureteral reflux (VUR) on the recurrence of UTI in infants.
Materials and Methods:
Infants with febrile UTI, without urogenital or neurological disorders, were prospectively enrolled for study. All underwent VCUG and 4 hours voiding observation with immediate PVR after each voiding. We did the 4 hours voiding observation usually one month after treatment of febrile UTI. Spinning top sign on voiding cystography and/ or interrupted free flow are regarded as LUTD. What is the interrupted flow? It means revoiding withing 5 minutes. Actually, this definition is different from that of staccato flow.
Results:
Totally 38 infants (M:F=26:11) with a mean age of 10.1+/-6.7 months were enrolled for study (Table 1 ). Mean followup period was 42.7+/-12.8 months. LUTD was present and absent in 27 and 11 children respectively. Of the 27 children with LUTD 21 (77.8%) had VUR, including 16 (59.3%) high grade VUR and 11 (40.7%) bilateral VUR. Of the 11 children without LUTD 5 (45.5%) had VUR, including 5 (45.5%) high grade VUR and 1 (9.1%) bilateral VUR. Anti-reflux treatment was performed in 5 (18.5%) children with LUTD and 1 (9.1%) child without LUTD. Recurrent UTI was observed in 13 (48.2%) with LUTD and 4 (36.4%) without UTI (p=0.51). Recurrent febrile UTI was noted in 6 (22.2%) children with LUTD and 0 (0.0%) without LUTD (p=0.088). LUTD with and without VUR were observed in 22 and 16 children respectively. Febrile UTI occurred in 6 (27.3%) and 0 (0.0%) of children with and without LUTD and VUR (p=0.023).
Conclusions:
LUTD with VUR may represent severe BBD and were associated with statistically higher rate of recurrent febrile UTI in infants.