Üriner Ultrasonografide Tespit Edilen Bozulmuş Distal Üreter Kontraksiyonu Vezikoüreteral Reflüyü Gösterebilir mi?

Yıl 2022, , 208 - 213, 29.12.2022

Avni Merter Keçeli , Muhammet İrfan Dönmez

https://doi.org/10.26650/jchild.2022.1099219

Öz

Amaç: Bu çalışmanın amacı, üriner ultrasonografi (US) ile saptanan bozulmuş distal üreter kontraksiyonunun vezikoüreteral reflü (VUR) varlığını tahmin edip edemeyeceğini belirlemekti. Gereç ve Yöntem: Kasım 2016 ile Eylül 2020 arasındaki hasta dosyalarının retrospektif analizi yapıldı. İşeme sistoüretrogramında (VCUG) VUR gösterilen ve VCUG muayenesinden sonraki bir hafta içinde üriner US yapılan toplam 248 çocuk çalışmaya dahil edildi. Hidronefroz derecesi, Society for Fetal Urology derecelendirme sistemine göre sınıflandırıldı ve VUR derecelendirmesi, International Reflux Study Group derecelendirme sistemine göre yapıldı. Bozulmuş distal üreter kontraksiyonu, distal üreterin hareketinin azalması ve mesaneye idrar çıkışının olmaması olarak tanımlandı. Bulgular: VUR derecesi ile hidronefroz derecesi arasında anlamlı bir ilişki vardı (p=0,0028). Ayrıca distal üreter dilatasyonu varlığı artan VUR derecesi ile ilişkiliydi (p=0,001). Bozulmuş distal üreter kontraksiyonu sadece dilate VUR’lu (derece III-V) çocuklarda mevcutken, derece IV ve VUR için VUR derecesi arasındaki ilişki anlamlı olarak yüksekti (p=0,001). Sonuç: Çocuklarda bozulmuş distal üreter kontraksiyonu, artan hidronefroz dereceleri ve distal üreter dilatasyonunun varlığı, dilatasyon yapan VUR’u saptamak için VCUG talep etme konusunda karar vermeye yardımcı olabilir.

Anahtar Kelimeler

Vezikoüreteral reflü, ultrasonografi, üreteral kontraksiyon

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Can Impaired Distal Ureteral Contraction Detected by Urinary Ultrasonography Indicate Presence of VUR?

Öz

Objective: The aim of this study was to determine if impaired distal ureteral contraction detected by urinary ultrasonography (US) could predict presence of vesicoureteral reflux (VUR). Materials and Methods: A Retrospective analysis of patients’ files between November 2016 and September 2020 was performed. A total of 248 children with demonstrated VUR on voiding cystourethrogram (VCUG) and who underwent urinary US within one week of the VCUG examination were included in the study. The degree of hydronephrosis was classified as per Society for Fetal Urology grading system and grading of VUR was done by the International Reflux Study Group grading system. The impaired distal ureteral contraction was defined as the reduced movement of the distal ureter as well as the deficiency of urine discharge into the bladder. Results: There was a significant correlation between the grade of VUR and the grade of hydronephrosis (p=0.0028). Also, the presence of distal ureteral dilation was related to increasing grades of VUR (p=0.001). The impaired distal ureteral contraction was present only in children with dilating VUR (grades III IV V) while its relationship between VUR grade was significantly high for grades IV and V VUR (p=0.001). Conclusion: In children, the impaired distal ureter contraction as well as the increase of grades of hydronephrosis, and the presence of distal ureteral dilation may aid decision-making in terms of requesting VCUG to detect dilating VUR.

Anahtar Kelimeler

VUR, VCUG, ultrasonography, children, radiation exposure

Proje Numarası

yok

Kaynakça

• 1. Soylu A, Demir BK, Turkmen M, et al. Predictors of renal scar in children with urinary infection and vesicoureteral reflux. Pediatr Nephrol 2008;23(12):2227-32. 2008/07/10. doi: 10.1007/s00467- 008-0907-x. google scholar
• 2. Lowe LH, Patel MN, Gatti JM, Alon US. Utility of follow-up renal sonography in children with vesicoureteral reflux and normal initial sonogram. Pediatrics 2004;113(3 Pt 1):548-50. 2004/03/03. doi: 10.1542/peds.113.3.548. google scholar
• 3. Subcommittee On Urinary Tract I. Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age. Pediatrics 2016;138(6). 2016/12/13. doi: 10.1542/ peds.2016-3026. google scholar
• 4. Bayram MT, Kavukcu S, Alaygut D, Soylu A, Cakmakci H. Place of ultrasonography in predicting vesicoureteral reflux in patients with mild renal scarring. Urology 2014;83(4):904-8. 2013/12/10. doi: 10.1016/j.urology.2013.10.019. google scholar
• 5. Hannula A, Venhola M, Perhomaa M, Pokka T, Renko M, Uhari M. Imaging the urinary tract in children with urinary tract infection. Acta Paediatr 2011;100(12):e253-9. 2011/06/30. doi: 10.1111/j.1651-2227.2011.02391.x. google scholar
• 6. Massanyi EZ, Preece J, Gupta A, Lin SM, Wang MH. Utility of screening ultrasound after first febrile UTI among patients with clinically significant vesicoureteral reflux. Urology 2013;82(4):905- 9. 2013/06/19. doi: 10.1016/j.urology.2013.04.026. google scholar
• 7. Suson KD, Mathews R. Evaluation of children with urinary tract infection--impact of the 2011 AAP guidelines on the diagnosis of vesicoureteral reflux using a historical series. J Pediatr Urol 2014;10(1):182-5. 2013/09/26. doi: 10.1016/j.jpurol.2013.07.025. google scholar
• 8. Huang FY, Tsai TC. Resolution of vesicoureteral reflux during medical management in children. Pediatr Nephrol 1995;9(6):715- 7. 1995/12/01. doi: 10.1007/BF00868720. google scholar
• 9. Schwentner C, Oswald J, Lunacek A, et al. Structural changes of the intravesical ureter in children with vesicoureteral reflux-does ischemia have a role? J Urol 2006;176(5):2212-8. 2006/10/31. doi: 10.1016/j.juro.2006.07.062. google scholar
• 10. Roshani H, Dabhoiwala NF, Dijkhuis T, Lamers WH. Intraluminal pressure changes in vivo in the middle and distal pig ureter during propagation of a peristaltic wave. Urology 2002;59(2):298-302. 2002/02/09. doi: 10.1016/s0090-4295(01)01550-3. google scholar
• 11. Oswald J, Brenner E, Schwentner C, et al. The intravesical ureter in children with vesicoureteral reflux: a morphological and immunohistochemical characterization. J Urol 2003;170(6 Pt 1): 2423-7. 2003/11/25. doi: 10.1097/01.ju.0000097146.26432.9a. google scholar
• 12. Hashitani H, Nguyen MJ, Noda H, et al. Interstitial cell modulation of pyeloureteric peristalsis in the mouse renal pelvis examined using FIBSEM tomography and calcium indicators. Pflugers Arch 2017; 469(5-6): 797-813. 2017/01/06. doi: 10.1007/s00424-016-1930-6. google scholar
• 13. Schwentner C, Oswald J, Lunacek A, et al. Loss of interstitial cells of Cajal and gap junction protein connexin 43 at the vesicoureteral junction in children with vesicoureteral reflux. J Urol 2005;174(5): 1981-6. 2005/10/12. doi: 10.1097/01.ju.0000176818.71501.93. google scholar
• 14. Arena S, Fazzari C, Arena F, et al. Altered ‘active’ antireflux mechanism in primary vesico-ureteric reflux: a morphological and manometric study. BJU Int 2007;100(2):407-12. 2007/05/30. doi: 10.1111/j.1464-410X.2007.06921.x. google scholar
• 15. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen- Mobius TE. International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol 1985;15(2):105-9. 1985/01/01. doi: 10.1007/BF02388714. google scholar
• 16. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 1993;23(6):478-80. 1993/01/01. doi: 10.1007/BF02012459. google scholar
• 17. Abdulnour HA, Williams JL, Kairalla JA, Garin EH. Does hydronephrosis predict the presence of severe vesicoureteral reflux? Eur J Pediatr 2012;171(11):1605-10. 2012/06/28. doi: 10.1007/s00431-012-1775-8. google scholar
• 18. Kovanlikaya A, Kazam J, Dunning A, et al. The role of ultrasonography in predicting vesicoureteral reflux. Urology 2014;84(5):1205-10. 2014/12/03. doi: 10.1016/j.urology.2014.06.057. google scholar
• 19. Nelson CP, Johnson EK, Logvinenko T, Chow JS. Ultrasound as a screening test for genitourinary anomalies in children with UTI. Pediatrics 2014;133(3):e394-403. 2014/02/12. doi: 10.1542/ peds.2013-2109. google scholar