Relationship among pediatric voiding dysfunction and vesicoureteral reflux and renal scars

To analyze the relationship among non-neurogenic voiding dysfunction, vesicoureteral reflux (VUR), and renal scarring, taking into consideration whether the reflux was unilateral or bilateral. VUR is a common problem in the pediatric age group. Although unilateral reflux is usually due to primary insufficiency of the vesicoureteral junction, bilateral reflux can also be the result of underlying voiding dysfunction.

Between 1993 and 1998, 80 children, 52 girls and 28 boys, median age 5.7 years (range 3.8 to 14), were evaluated because of VUR. Eighteen patients who presented with associated anomalies and obvious neuropathic bladder dysfunction were excluded from the study. Complete urologic, neurologic, and urodynamic investigations were performed in all patients.

Of 62 patients, 25 (40.3%) had unilateral and 37 (59.6%) had bilateral reflux. Voiding dysfunction was found in 7 patients (28%) with unilateral reflux and in 27 patients (72.9%) with bilateral reflux (P <0.01 ). Two (25%) of the 8 patients with unilateral reflux and renal scarring had voiding dysfunction but no demonstrable urinary tract infection, and 10 (55.5%) of the 18 patients with bilateral reflux and renal scarring had voiding dysfunction and no demonstrable urinary tract infection (P <0.01).

If VUR is bilateral, the prevalence of existing underlying voiding dysfunction seems to be higher. The first step in management should be a detailed evaluation of bladder function to choose an appropriate treatment modality and to prevent renal deterioration.