Urodynamical findings on women with voiding problems and earlier vesico-ureteral reflux

Examine bladder function behind an abnormal urine flow curve pattern or lower urinary tract symptoms (LUTS) in women with earlier vesicoureteral reflux (VUR).

Seventeen earlier female VUR patients with weak, fractionated or tower-shaped flow pattern, 10 patients with normal voiding and 2 patients with a big bladder were urodynamically studied.

A third of the patients had a large (>800 ml) cystometric bladder capacity. Sensitivity of the bladder was decreased especially in weak urine flow group. Half of these patients felt the "first sensation" when at least 40% of the bladder capacity was filled. Neither the earlier treatment modality nor grade of childhood VUR had an influence on the bladder sensitivity. Urinary tract infections were reported significantly more often (P = 0.028) in patients with decreased bladder sensitivity than in the other patients. Overactive detrusor and decreased bladder compliance were uncommon findings. The detrusor pressure was good exceeding 15 cm H(2)O during the maximum flow rate in almost all patients. Abnormal sphincteric EMG activity during voiding was found in 70% of all patients and especially in fractionated flow group (89%). The EMG activity was seen twice as often in patients with earlier bilateral dilating VUR as in those who had suffered of non-dilating VUR (P = 0.005).

Despite of high frequency of symptoms in female patients with earlier VUR, detrusor overactivity was a rarity, but decreased sensitivity and large capacity of the bladder were found frequently. The patients with weak or fractionated urine flow seemed to suffer from an overactive urethral sphincter.