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The Swedish reflux trial in children: v. Bladder dysfunction.

Ulla Sillén¹, Per Brandström, Ulf Jodal

¹Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg and Department of Pediatrics, Children's University Hospital (IS), Lund, Sweden. ulla.sillen@vgregion.se

The Journal of Urology

|May 22, 2010

Summary

Lower urinary tract dysfunction is common in children with severe vesicoureteral reflux. This dysfunction correlates with persistent reflux and kidney damage, but not initial presentation.

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Area of Science:

Pediatric Urology
Nephrology
Pediatric Nephrology

Background:

Vesicoureteral reflux (VUR) is a common condition in children.
Grades III and IV VUR represent significant reflux, potentially leading to complications.
Understanding lower urinary tract dysfunction (LUTD) is crucial for managing VUR outcomes.

Purpose of the Study:

To determine the prevalence and types of LUTD in children with VUR grades III and IV.
To investigate the relationship between LUTD and improved reflux, renal damage, and recurrent urinary tract infections (UTIs).

Main Methods:

A prospective, randomized, controlled, multicenter study involving 203 children (ages 1 to <2 years) with VUR grades III and IV.
Utilized voiding cystourethrography and dimercaptosuccinic acid scintigraphy at baseline and 2-year follow-up.
Assessed LUTD via noninvasive methods, including voiding observation and post-void residual measurements.

Main Results:

At baseline, 20% of patients exhibited LUTD (high bladder capacity, increased post-void residual urine).
At 2 years, LUTD prevalence increased to 34%, with 9% having overactive bladder and 24% having voiding phase dysfunction.
LUTD at 2 years negatively correlated with improved reflux (p=0.002) and was associated with renal damage (p=0.001).
Recurrent UTIs were more frequent in children with LUTD (33%) compared to those without (20%), though not statistically significant (p=0.084).

Conclusions:

A significant proportion of children with dilating reflux develop LUTD post-toilet training, primarily voiding phase issues.
LUTD is linked to persistent VUR and renal damage.
Initial LUTD at study entry did not predict 2-year outcomes.