Médecine factuelle et reflux vésico-urétéral

Annales D Urologie Pub Date : 2006-06-01 DOI:10.1016/j.anuro.2006.02.005

D. Demède (interne), A. Cheikhelard (assistante-chef de clinique), M. Hoch (interne), P. Mouriquand (chirurgien des hôpitaux, professeur à la faculté, chef de service)

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引用次数: 11

Abstract

Vesicoureteral reflux (VUR) remains one of the most controversial subjects in paediatric urology. Much literature has been published on VUR, making the understanding of this anomaly and its treatments quite opaque. Evidence-Based Medicine (EBM) should be helpful to clarify the various VUR approaches contained in the 6224 titles found on Medline using the keywords “vesicoureteral reflux” and “vesicoureteric reflux”. These articles were critically reviewed and graded according to EBM scorings, with regard to their methodological designs. This review of VUR literature suggests that most of our knowledge is based on publications with a low level of evidence, and that EBM lacks arguments to support recommendations for VUR diagnostic and treatment. It appears yet that antenatal dilatation of the urinary tract and symptomatic urinary tract infections (UTI) justify VUR screening. Surgery should be discussed in recurrent UTIs or deterioration of renal function. There is no consensus in case of persistent asymptomatic VUR regarding indication and duration of antibio-prophylaxis, and selection of radical treatment.

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循证医学与膀胱输尿管反流

膀胱输尿管反流(VUR)仍然是儿科泌尿科最具争议的主题之一。许多关于VUR的文献已经发表，使得对这种异常的理解及其治疗相当不透明。循证医学(EBM)应该有助于澄清在Medline上发现的6224个标题中使用关键词“膀胱输尿管反流”和“膀胱输尿管反流”所包含的各种VUR方法。这些文章经过严格审查，并根据EBM评分进行评分，考虑到他们的方法设计。对VUR文献的回顾表明，我们的大部分知识都是基于证据水平较低的出版物，并且EBM缺乏支持VUR诊断和治疗建议的论据。目前看来，产前尿路扩张和症状性尿路感染(UTI)证明了VUR筛查的合理性。复发性尿路感染或肾功能恶化应考虑手术治疗。对于持续性无症状VUR，关于抗菌素预防的适应症和持续时间以及根治性治疗的选择尚无共识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Annales D Urologie 医学-泌尿学与肾脏学

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