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Urodynamic dysfunction in infants with vesicoureteral reflux.

M Chandra1, H Maddix

  • 1Department of Pediatrics, North Shore University Hospital-New York University Hospital School of Medicine, Manhasset, NY 11030, USA.

The Journal of Pediatrics
|June 6, 2000
PubMed
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High voiding pressures and inadequate sphincter relaxation contribute to pediatric vesicoureteral reflux (VUR). Urodynamic dysfunction is common in infants with VUR, regardless of sex or urinary tract infection (UTI) status.

Area of Science:

  • Pediatric Urology
  • Urodynamics
  • Nephrology

Background:

  • Vesicoureteral reflux (VUR) in infants can stem from short ureteric tunnels or urodynamic issues.
  • VUR and symptomatic urinary tract infections (UTIs) are more prevalent in male infants, potentially linked to functional obstruction.

Purpose of the Study:

  • To investigate the role of urodynamic dysfunction and inadequate sphincteric relaxation in primary VUR in infants.
  • To evaluate the relationship between VUR severity, voiding pressures, and external urethral sphincter function.

Main Methods:

  • Urodynamic studies were performed on 75 infants diagnosed with primary VUR.
  • Voiding cystourethrograms (VCUGs) were retrospectively reviewed for evidence of inadequate external urethral sphincter relaxation during voiding.

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Main Results:

  • 79% of infants with primary VUR exhibited high voiding detrusor pressure, increased postvoid residual, or detrusor-sphincter dyssynergy.
  • Infants with bilateral high-grade VUR showed increased detrusor hyper-reflexia and voiding pressures compared to those with lower grades or unilateral VUR.
  • Inadequate external urethral sphincter relaxation was observed in 10 of 47 male infants on VCUG.

Conclusions:

  • Elevated intravesical pressures are implicated in the development and severity of VUR.
  • High voiding detrusor pressure in some infants with primary VUR may be associated with inadequate external urethral sphincter relaxation.