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Bladder dynamics and vesicoureteral reflux: factors associated with idiopathic lower urinary tract dysfunction in
Zeliha Ural1, Ibrahim Ulman, Ali Avanoglu
1Department of Pediatric Surgery, Division of Pediatric Urology, Faculty of Medicine, Ege University, Izmir, Turkey. zelihaural@gmail.com
Insights
Vesicoureteral reflux (VUR) is linked to daytime incontinence, UTIs, and younger age in children with idiopathic lower urinary tract dysfunction. Increased bladder pressure is a key factor, and initial bladder capacity predicts VUR resolution.
Area of Science:
- Pediatric Urology
- Nephrology
- Urodynamics
Background:
- Idiopathic lower urinary tract dysfunction (ILUTD) is common in children.
- Vesicoureteral reflux (VUR) is a significant concern in this population.
- Understanding the characteristics associated with VUR is crucial for effective management.
Purpose of the Study:
- To identify clinical, demographic, urodynamic, and prognostic factors related to VUR in children with ILUTD.
- To compare these characteristics between children with and without VUR.
Main Methods:
- Retrospective review of 348 children with ILUTD (detrusor overactivity or dysfunctional voiding).
- Analysis of demographic, clinical, and urodynamic data.
- Comparison of parameters based on VUR presence, grade, laterality, and resolution.
Main Results:
- VUR was present in 46% of patients (155/340).
- Younger age, daytime incontinence, and urinary tract infections (UTIs) were associated with VUR.
- VUR increased the rate of renal cortical abnormalities in children with UTIs.
- Higher median maximum filling pressure was observed in the VUR group.
- 40% of VUR cases resolved with medical treatment, with higher resolution rates in nondilating reflux and smaller bladder capacity.
Conclusions:
- VUR in children with ILUTD is associated with daytime incontinence, UTIs, younger age, and renal cortical abnormalities.
- Elevated intravesical pressures appear to be a primary driver of VUR in this cohort.
- Initial bladder capacity is a predictor of VUR resolution.
Purpose:
The objective of this study was to determine the clinical, demographic, urodynamic and prognostic characteristics related to vesicoureteral reflux among patients with idiopathic lower urinary tract dysfunction.
Materials And Methods:
We retrospectively reviewed the records of 348 children with idiopathic detrusor overactivity or dysfunctional voiding who had been examined for vesicoureteral reflux between 1995 and 2005 at a university hospital. Demographic, clinical and urodynamic parameters were compared between groups according to the presence, grade, laterality and resolution of vesicoureteral reflux.
Results:
Among the 348 patients 8 infants were excluded from statistical analysis and are discussed separately. Among the 340 remaining patients 1 year and older vesicoureteral reflux was documented in 155 (46%), of whom 32% had bilateral reflux. Of the overall cases 60% were grade III or higher. Mean age in the refluxing group (6.5 +/- 2.8 years) was significantly lower than in the nonrefluxing group (7.6 +/- 2.5 years, p <0.001). Continent children presented with a significantly higher rate of vesicoureteral reflux compared to incontinent children (74% vs 42%, p <0.001). Among the patients who had urinary tract infection the presence of reflux increased the rate of renal cortical abnormalities (45% vs 17%, p <0.001). However, among patients who were free of urinary tract infection the presence of reflux was not associated with cortical abnormalities (25% vs 24%, p >0.05). Median maximum filling pressure was higher in the refluxing group compared to the nonrefluxing group (40.0 vs 34.0 cm H(2)O, p <0.001). Detrusor overactivity and dysfunctional voiding showed similar rates for development of vesicoureteral reflux. Reflux was resolved with medical treatment in 40% of the patients. The resolution rate was significantly higher in children with nondilating reflux and initial lower median cystometric bladder capacity.
Conclusions:
Vesicoureteral reflux is associated with daytime incontinence, urinary tract infection, younger age and renal cortical abnormalities among patients with idiopathic lower urinary tract dysfunction. Increased intravesical pressures seem to be the primary factor for inducing reflux in idiopathic lower urinary tract dysfunction. Initial bladder capacity predicts the resolution of reflux.
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