Diagnóstico e tratamento do refluxo vesicoureteral na infância: experiência de 30 anos em instituição brasileira não universitária
Carregando...
Data
2004
Autores
Zerati Filho, Miguel [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Propósito Nosso objetivo foi avaliar crianças com refluxo vesico-ureteral em três diferentes décadas. Material e Métodos No período de janeiro de 1970 à dezembro de 2000, foram avaliados retrospectivamente 417 meninas e 94 meninos portadores de refluxo vesicoureteral primário. Os pacientes foram divididos em 3 décadas: grupo A (1970 a 1980) (n = 80); grupo B (1981 a 1990) (n = 205) e grupo C (1991 a 2000) (n = 226) . Foram analisadas as manifestações clínicas, resolução espontânea, cicatrizes renais e indicações cirúrgicas. Utilizamos a Curva de Kaplan-Meier para definir a probabilidade de resolução espontânea. Resultados A manifestação clínica mais freqüente foi infecção do trato urinário em 85% dos casos. Em 48,9% o refluxo era unilateral e bilateral em 51,1%, sendo 48 (9,4%), 192 (37,6%), 174 (34%), 74 (14,5%) e 23 (4,5%) graus I, II, III, IV e V respectivamente. Observou-se cicatrizes renais em 31%, 20,5% e 13,7% nos grupos A, B, C respectivamente. Em 125 crianças foram realizadas correções cirúrgicas do RVU, sendo 24 (30%), 62 (30,2%) e 39 (17,2%) nos grupos A, B, e C; com diminuição significativa no grupo C. Obtivemos 293 (57,1%) de resolução espontânea, sendo 42 (87.5%), 149 (77,6%), 92 (52,8%), 9 (12,2%) e 1 (4,3%) nos graus I, II, III, IV e V respectivamente. Conclusão Notamos redução espontânea significativamente maior nos RVU graus I a III. Houve significativa diminuição na incidência de lesões renais e nas indicações cirúrgicas do RVU na última década.
Purpose Our objective was to evaluate children with vesicoureteral reflux in three different decades. Material and Methods From January 1970 to December 2000, 417 girls and 94 boys with primary vesicoureteral reflux were retrospectively evaluated. Patients were divided into 3 decades, group A (1970 to 1980) (n = 80); group B (1981 to 1990) (n = 205) and group C (1991 to 2000) (n = 226). Clinical manifestations, spontaneous resolution, renal scars and surgical indications were assessed. The Kaplan-Meier curve was used to define the probability of spontaneous resolution. Results The most frequent clinical manifestation was urinary tract infection in 85% of the cases. Unilateral reflux was observed in 48.9% and bilateral reflux in 51.1%, 48 (9.4%), 192 (37.6%), 174 (34%), 74 (14.5%) and 23 (4.5%) were grade I, II, III, IV and V respectively. Renal scars were observed in 31%, 20.5% and 13.7% of the patients in groups A, B, C, respectively. In 125 children VUR repair surgeries were carried out, 24 (30%), 62 (30.2%) and 39 (17.2%) in groups A, B, and C; with a significant decrease in group C. There were 293 cases (57.1%) of spontaneous resolution, 42 (87.5%), 149 (77.6%), 92 (52.8%), 9 (12.2%) and 1 (4.3%) were grade I, II, III, IV and V, respectively. Conclusion A significantly higher rate of spontaneous resolution was observed in grades I to III VUR. There was a significant decrease in the incidence of renal injuries and surgical indications for VUR in the last decade.
Purpose Our objective was to evaluate children with vesicoureteral reflux in three different decades. Material and Methods From January 1970 to December 2000, 417 girls and 94 boys with primary vesicoureteral reflux were retrospectively evaluated. Patients were divided into 3 decades, group A (1970 to 1980) (n = 80); group B (1981 to 1990) (n = 205) and group C (1991 to 2000) (n = 226). Clinical manifestations, spontaneous resolution, renal scars and surgical indications were assessed. The Kaplan-Meier curve was used to define the probability of spontaneous resolution. Results The most frequent clinical manifestation was urinary tract infection in 85% of the cases. Unilateral reflux was observed in 48.9% and bilateral reflux in 51.1%, 48 (9.4%), 192 (37.6%), 174 (34%), 74 (14.5%) and 23 (4.5%) were grade I, II, III, IV and V respectively. Renal scars were observed in 31%, 20.5% and 13.7% of the patients in groups A, B, C, respectively. In 125 children VUR repair surgeries were carried out, 24 (30%), 62 (30.2%) and 39 (17.2%) in groups A, B, and C; with a significant decrease in group C. There were 293 cases (57.1%) of spontaneous resolution, 42 (87.5%), 149 (77.6%), 92 (52.8%), 9 (12.2%) and 1 (4.3%) were grade I, II, III, IV and V, respectively. Conclusion A significantly higher rate of spontaneous resolution was observed in grades I to III VUR. There was a significant decrease in the incidence of renal injuries and surgical indications for VUR in the last decade.
Descrição
Palavras-chave
Refluxo vesicoureteral, Crianças - Doenças - Tratamento
Como citar
ZERATI FILHO, Miguel. Diagnóstico e tratamento do refluxo vesicoureteral na infância: experiência de 30 anos em instituição brasileira não universitária. 2004. 62 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2004.