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Treatment of bladder dysfunction and high grade vesicoureteral reflux does not influence the spontaneous resolution

U Sillén1, G Holmdahl, A L Hellström

  • 1Pediatric Uro-Nephrological Centre, Queen Silvia Children's Hospital, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. ulla.sillen@vgregion.se

The Journal of Urology
|December 13, 2006
PubMed

Insights

Treating bladder dysfunction in infants with high-grade vesicoureteral reflux (VUR) did not improve spontaneous VUR resolution. However, clean intermittent catheterization reduced recurrent urinary tract infections in these infants.

Area of Science:

  • Pediatric Urology
  • Nephrology

Background:

  • Congenital high-grade vesicoureteral reflux (VUR) in infants often presents with bladder dysfunction, including high capacity and poor emptying.
  • This dysfunction can be associated with recurrent urinary tract infections (UTIs).

Purpose of the Study:

  • To investigate if treating bladder dysfunction in infants with congenital high-grade VUR influences spontaneous reflux resolution.
  • To determine the effect of this treatment on the rate of recurrent UTIs.

Main Methods:

  • A cohort of 20 infants with mainly grade V VUR and bladder dysfunction were treated with clean intermittent catheterization (CIC) from infancy until a median age of 4 years.
  • Bladder function, reflux resolution, and UTI recurrence were monitored throughout the study period.

Main Results:

  • Infants in the CIC group maintained high bladder capacity and high post-void residual volumes, particularly between ages 1 and 2 years.
  • Spontaneous VUR resolution occurred in only one patient during the 4-year follow-up; 18 patients ultimately required surgical intervention.
  • Recurrent UTIs were uncommon after the initiation of CIC treatment.

Conclusions:

  • Treatment of bladder dysfunction in infants with high-grade VUR does not enhance spontaneous reflux resolution.
  • Clean intermittent catheterization appears to decrease the incidence of recurrent urinary tract infections in this patient population.
Abstract

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