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Urodynamic pattern in asymptomatic infants: siblings of children with vesicoureteral reflux
M Bachelard1, U Sillén, S Hansson
1Department of Pediatric Radiology, Sahlgren's University Hospital-Ostra, Göteborg, Sweden.
Insights
This study provides reference urodynamic data for infants without vesicoureteral reflux (VUR). Findings suggest physiological dyscoordination, possibly due to immature detrusor-sphincter function, especially in male infants.
Area of Science:
- Pediatric Urology
- Urodynamics
- Infant Health
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Identifying risk factors and normal physiological patterns in siblings is crucial for early detection and management.
- Asymptomatic siblings of children with VUR represent a key population for studying subclinical urodynamic findings.
Purpose of the Study:
- To investigate the urodynamic patterns in asymptomatic infants who are siblings of children diagnosed with VUR.
- To establish reference data for normal urodynamics in early infancy.
- To identify potential indicators of bladder dysfunction in this at-risk population.
Main Methods:
- Cystometry and perineal electromyography were performed in conjunction with voiding cystourethrography.
- The study included 16 male and 21 female infant siblings screened for VUR.
- Participants ranged in age from 0.2 to 7.3 months, with a median age of 1.1 months.
Main Results:
- Vesicoureteral reflux (VUR) was detected in 25% of males and 10% of females.
- In infants without VUR, unstable bladder contractions were observed in 8% of males and 16% of females.
- Maximum voiding detrusor pressure was significantly higher in males (median 127 cm H2O) compared to females (median 72 cm H2O), with lower-than-expected bladder capacity (median 20 ml).
Conclusions:
- The study provides valuable reference urodynamic data for asymptomatic infants, particularly siblings of VUR patients.
- Instability was infrequent, but bladder capacity was lower than anticipated.
- The observed urodynamic voiding pattern suggests physiological dyscoordination, likely stemming from immature detrusor-sphincter function, especially noted in male infants.
Purpose:
We studied the urodynamic pattern in asymptomatic infants who are siblings of children with vesicoureteral reflux.
Materials And Methods:
Cystometry and perineal electromyography were performed with voiding cystourethrography in 16 male and 21 female infant siblings screened for reflux at age 0.2 to 7.3 months (median 1.1).
Results:
Vesicoureteral reflux was present in 25% of the male and 10% of the female infants. In those without vesicoureteral reflux unstable bladder contractions were noted in 8% of the male and 16% of the female subjects. In these infants median maximum voiding detrusor pressure was 127 (range 84 to 211) and 72 cm. water (range 42 to 240), respectively, and median bladder capacity was 20 ml. (range 10 to 49 and 10 to 120, respectively). Maximum voiding detrusor pressure was significantly higher in male than in female infants (p <0.01). Perineal electromyography was interpretable in 13 of the 16 male and 16 of the 21 female infants overall. All but 1 female subject had increased activity during voiding, which was also present intermittently in all subjects.
Conclusions:
Our study of asymptomatic siblings of children with vesicoureteral reflux has provided results that may be used as reference data for normal urodynamics in early infancy. Instability was rare. Bladder capacity was lower than expected with a predicted capacity at birth of approximately 20 ml. Maximum voiding pressure was high, especially in male subjects. The urodynamic voiding pattern suggests physiological dyscoordination, probably due to immature detrusor-sphincter function.