urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2025-13-1-27-38urovest-1007Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESМикробиота мочепузырной мочи у детей с пузырномочеточниковым рефлюксом перед его оперативным лечениемBladder urine microbiota in children with vesicoureteral reflux: preoperative valueshttps://orcid.org/0000-0002-4808-7024НабокаЮ. Л.NabokaYu. L.

Юлия Лазаревна Набока — д-р мед. наук, профессор

Ростов-на-Дону

 Yulia L. Naboka — Dr.Sc.(Med), Full Prof.

Rostov-on-Don

nagu22@mail.ruhttps://orcid.org/0000-0001-9145-8671СизоновВ. В.SizonovV. V.

Владимир Валентинович Сизонов — д-р мед. наук, профессор

Ростов-на-Дону

Vladimir V. Sizonov — Dr.Sc.(Med), Full Prof.

Rostov-on-Don

vsizonov@mail.ruhttps://orcid.org/0000-0002-5595-8799КотиеваЕ. М.KotievaE. M.

Елизавета Михайловна Котиева

Ростов-на-Дону

 Elizaveta M. Kotieva

Rostov-on-Don

elizaveta.kotieva@mail.ruhttps://orcid.org/0009-0000-8368-3684ГлуховаВ. В.GlukhovaV. V.

Валентина Владимировна Глухова

Ростов-на-Дону

Valentina V. Glukhova

Rostov-on-Don

valya_glukhova17@mail.ruhttps://orcid.org/0000-0003-0995-7848ГудимаИ. А.GudimaI. A.

Ирина Александровна Гудима — д-р мед. наук, профессор

Ростов-на-Дону

 Irina A. Gudima — Dr.Sc.(Med), Full Prof.

Rostov-on-Don

nagu22@mail.ruhttps://orcid.org/0000-0003-1360-8608КудряЕ. В.KudryyaE. V.

Елена Васильевна Кудря — канд. мед. наук

Ростов-на-Дону

Elena V. Kudryya — Сand.Sc.(Med)

Rostov-on-Don

nagu22@mail.ruhttps://orcid.org/0009-0000-3979-7510АнопкоА. И.AnopkoA. I.

Ростов-на-Дону

Anastasia I. Anopko

Rostov-on-Don

anastasiyaan2696@gmail.comhttps://orcid.org/0009-0004-7701-5064РодинаР. А.RodinaR. A.

Роза Алексеевна Родина

Ростов-на-Дону

Roza A. Rodina

Rostov-on-Don

rozarodina0208@yandex.ruhttps://orcid.org/0000-0002-1710-0169КоганМ. И.KoganM. I.

Михаил Иосифович Коган — д-р мед. наук, профессор, заслуженный деятель науки РФ 

Ростов-на-Дону

Mikhail I. Kogan — Dr.Sc.(Med), Full Prof., Hons. Sci. of the Russian Federation

Rostov-on-Don

dept_kogan@mail.ruРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian FederationРостовский государственный медицинский университет; Областная детская клиническая больницаРоссияRostov State Medical University ; Rostov Regional Children's Clinical HospitalRussian Federation2025010320251312738Copyright © Набока Ю.Л., Сизонов В.В., Котиева Е.М., Глухова В.В., Гудима И.А., Кудря Е.В., Анопко А.И., Родина Р.А., Коган М.И., 20252025Набока Ю.Л., Сизонов В.В., Котиева Е.М., Глухова В.В., Гудима И.А., Кудря Е.В., Анопко А.И., Родина Р.А., Коган М.И.Naboka Y.L., Sizonov V.V., Kotieva E.M., Glukhova V.V., Gudima I.A., Kudryya E.V., Anopko A.I., Rodina R.A., Kogan M.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/1007Введение

Введение. Инфекции мочевых путей (ИМП) часто встречаются у детей, особенно при анатомических аномалиях, таких как пузырно-мочеточниковый рефлюкс (ПМР). Диагностика ПМР обычно следует за эпизодом ИМП, что подчёркивает важность раннего выявления ПМР при ИМП для предотвращения почечных осложнений. Вопрос тактики ведения первой фебрильной ИМП остаётся спорным: педиатры рекомендуют диагностику после повторных ИМП, тогда как урологи настаивают на ранней визуализации и профилактике. Антибиотикопрофилактика (АБП) перед операцией помогает снизить риск рецидивов ИМП, но вызывает резистентность и изменяет микробиоту.

Цель исследования

Цель исследования. Оценить микробиоту мочепузырной мочи у детей перед операцией по поводу ПМР.

Материалы и методы

Материалы и методы. В исследование включены 40 детей (12 мальчиков — группа 1, 28 девочек —группа 2), у которых ПМР выявлен после манифестной инфекции мочевых путей. Контрольные группы — 18 здоровых мальчиков (группа 3) и 16 здоровых девочек (группа 4). Сбор мочи и её культуральное исследование осуществляли с использованием расширенного набора питательных сред (10 – 12) для культивирования аэробных и анаэробных таксонов микробиоты.

Результаты

Результаты. Медианный возраст пациентов с ПМР в исследуемых группах 3,6 года, причём среди них было больше девочек (p < 0,001). Моча детей с ПМР была нестерильной, в ней были обнаружены 27 таксонов микроорганизмов, из которых 16 — аэробы и 11 — анаэробы. Доминирующие таксоны различались по группам: у мальчиков с ПМР преобладали Enterobacterales, Peptococcus spp. и Anaerococcus spp., у девочек с ПМР — коагулазонегативные стафилококки, Corynebacterium spp. и Peptococcus spp. Большинство микроорганизмов обнаруживалось в ассоциациях. Медиана уровня бактериурии в основном составила 10² КОЕ/мл. В целом у здоровых детей и у пациентов с ПМР выявлено 29 таксонов микробиоты с доминированием аэробноанаэробных взаимосвязей. У пациентов с ПМР достоверных корреляционных связей между различными таксонами микробиоты мочи было больше, чем у здоровых детей.

Заключение

Заключение. Мочепузырная моча у детей с ПМР содержит аэробные и анаэробные бактерии. Повышают ли ассоциации бактерий при бактериурии 10² КОЕ/мл риск ИМП при хирургии ПМР, ещё предстоит выяснить, однако дисбиоз мочепузырной мочи следует исследовать как возможный фактор риска ИМП. Необходимы дальнейшие исследования для обоснования целесообразности и подбора селективной АБП в лечении ПМР.

Introduction

Introduction. Urinary tract infections (UTIs) are prevalent among children, particularly those with anatomical anomalies such as vesicoureteral reflux (VUR). The diagnosis of VUR typically follows an episode of UTI, highlighting the importance of early detection of VUR in case of UTIs to prevent renal complications. The management of a first febrile UTI remains a subject of debate among medical professionals. Pediatricians often recommend diagnosing VUR after recurrent UTIs, while urologists advocate for early imaging and prophylaxis. Antibiotic prophylaxis (ABP) before surgery can reduce the risk of recurrent UTIs; however, it also induces antibiotic resistance and alters the microbiota.

Objective

Objective. To evaluate the microbiota of bladder urine in children before surgery for VUR.

Materials & methods

Materials & methods. The study included 40 children (12 boys — group 1, 28 girls — group 2) diagnosed with MTCT after symptomatic urinary tract infection. The control groups were 18 healthy boys (group 3) and 16 healthy girls (group 4). Urine was collected and cultured using an expanded set of nutrient media (10–12) for culturing aerobic and anaerobic taxa of microbiota.

Results

Results. The median age of VUR-patients in the study groups was 3.6 years. A statistically significant predominance of girls was observed (p < 0.001). The urine samples from VUR-children were unsterile, and a total of 27 taxa of microorganisms were detected. Among them, 16 taxa were aerobes, and 11 taxa were anaerobes. The dominant taxa differed between the groups: Enterobacterales, Peptococcus spp., and Anaerococcus spp. predominated in VURboys, while coagulase-negative staphylococci, Corynebacterium spp., and Peptococcus spp. dominated in VUR-girls. Most microorganisms were found in associations. The median bacteriuria level was mostly 10² CFU/ml. In total, 29 microbiota taxa with dominant aerobic-anaerobic relationships were identified in healthy children and VUR-patients. There were more significant correlations between different taxa of the urine microbiota in VUR-patients compared to healthy children.

Conclusion

Conclusion. Bladder urine from VUR-children contains aerobic and anaerobic bacteria. It is yet to be determined whether bacterial associations with a bacteriuria of 10² CFU/ml increase the risk of UTIs in VUR surgery, but urinary dysbiosis should be investigated as a possible risk factor for UTIs. Further studies are needed to justify the feasibility and suitability of selective ABP in the treatment of VUR.

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The authors declare that there are no conflicts of interest present.