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Updated: Jul 11, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Identification of filling versus voiding reflux as predictor of clinical outcome
Amir Arsanjani1, Madhu Alagiri
1Department of Surgery, Division of Urology, University of California, San Diego, Medical Center, San Diego, California 92103-8897, USA.
Insights
Vesicoureteral reflux (VUR) identified during the filling phase of a voiding cystourethrogram often requires surgery. VUR identified during the voiding phase predicts spontaneous resolution in children.
Area of Science:
- Pediatric Urology
- Radiology
- Nephrology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Diagnosis is typically made via voiding cystourethrography (VCUG).
- VCUG identifies reflux during either the filling or voiding phase.
Purpose of the Study:
- To determine if the radiologic distinction between filling and voiding reflux has prognostic significance.
- To evaluate the association between reflux phase identification and clinical outcomes.
Main Methods:
- Retrospective chart review of 201 pediatric patients with primary VUR.
- Analysis of patient age, sex, and reflux grade.
- Statistical analysis including chi-square, ANOVA, and Kaplan-Meier.
Main Results:
- 57% of patients had filling reflux, 43% had voiding reflux.
- Filling reflux was associated with higher rates of surgery (46%) and lower spontaneous resolution (23%).
- Voiding reflux was associated with lower surgical rates (14%) and higher spontaneous resolution (66%).
Conclusions:
- VUR identified during the filling phase predicts a higher likelihood of surgical intervention.
- VUR identified during the voiding phase is associated with greater spontaneous resolution.
- This distinction, along with reflux grade, aids in predicting VUR outcomes in children.
Objectives:
In children diagnosed with vesicoureteral reflux (VUR), the identification of reflux is made during either the filling (filling reflux) or voiding (voiding reflux) phase of the voiding cystourethrogram. A retrospective study was performed to determine whether this radiologic distinction has prognostic significance.
Methods:
A retrospective chart review was performed of patients who had undergone voiding cystourethrography from July 1999 to June 2004. Patient age, sex, and reflux grade (unilateral and bilateral) were independently examined in relation to spontaneous resolution, surgical intervention, or observation. These data were subjected to chi-square, analysis of variance with post hoc test, and Kaplan-Meier analysis.
Results:
The diagnosis of primary VUR was identified in 218 patients, and sufficient chart information and hardcopy films to permit identification of filling versus voiding reflux were available for 201. Of 201 patients, 115 (57%) had filling reflux and 86 (43%) had voiding reflux. Of the 115 with filling reflux, 53 (46%) underwent surgery and 27 (23%) had spontaneous resolution (P <0.001). Of the 86 patients with voiding reflux, 12 (14%) underwent surgery and 57 (66%) had spontaneous resolution (P <0.0001). Advanced age and grade of reflux were independently associated with surgical intervention (P <0.0001 and P <0.04, respectively).
Conclusions:
Our results have shown that VUR that is first identified during the filling phase of the initial voiding cystourethrogram is more likely to require surgical intervention. In contrast, VUR that is first identified during the voiding phase was independently associated with a greater rate of spontaneous resolution. This radiologic distinction, in addition to reflux grade, might be useful in predicting the clinical outcome for children diagnosed with primary VUR.
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