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Urodynamic dysfunction in infants with vesicoureteral reflux
1Department of Pediatrics, North Shore University Hospital-New York University Hospital School of Medicine, Manhasset, NY 11030, USA.
Insights
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.
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.
Patients And Methods:
Vesicoureteral reflux (VUR) may result from inadequate length of the intravesical ureteric tunnel and from urodynamic dysfunction. VUR and symptomatic urinary tract infection (UTI) are both more common in male infants and may be related to urodynamic dysfunction and functional intravesical obstruction. We therefore conducted urodynamic studies in 75 infants with primary VUR and retrospectively evaluated their voiding cystourethrogram (VCUG) for evidence of inadequate sphincteric relaxation.
Results:
High voiding detrusor pressure (>70 cm H(2)O), increased postvoid residual (>2 mL/kg body weight), or detrusor-sphincter dyssynergy were observed in 79% of infants with primary VUR without significant differences between male and female infants or in infants with or without UTI. Infants with bilateral grade IV-V VUR showed a higher prevalence of detrusor hyper-reflexia and higher voiding detrusor pressure than infants with lower grades of VUR or unilateral grade IV-V VUR. On VCUG, inadequate external urethral sphincter relaxation during voiding was noted in 10 of 47 male infants.
Conclusions:
The findings suggest that high intravesical pressures contribute to the development and severity of VUR, and that high voiding detrusor pressure in some infants with primary VUR may be related to inadequate relaxation of the external urethral sphincter.