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Urodynamic abnormalities in toilet trained children with primary vesicoureteral reflux
Young Kwon Hong1, Emanuela Altobelli, Joseph G Borer
1Department of Urology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
Insights
Children with vesicoureteral reflux and lower urinary tract symptoms often have overactive bladder findings. Dysfunctional voiding is more common in younger children, suggesting tailored treatments for voiding dysfunction are crucial.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Urodynamics
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Understanding associated urodynamic abnormalities is key for effective management.
- Toilet training status and lower urinary tract symptoms (LUTS) may influence VUR and bladder function.
Purpose of the Study:
- To investigate urodynamic abnormalities in toilet-trained children diagnosed with primary vesicoureteral reflux.
- To correlate urodynamic findings with patient demographics, LUTS, and VUR severity.
Main Methods:
- Urodynamic evaluation was performed on 298 toilet-trained children with primary VUR.
- Parameters assessed included bladder compliance, bladder capacity, and detrusor activity.
- Data were analyzed in relation to age, gender, LUTS, and reflux grade.
Main Results:
- Children with LUTS showed significantly less severe VUR compared to those without LUTS.
- Decreased late bladder compliance and detrusor overactivity were more prevalent in children with LUTS.
- Dysfunctional voiding was more frequent in younger children (2.5-4 years) with VUR and LUTS.
Conclusions:
- LUTS in children with VUR are associated with urodynamic findings of overactive bladder and inversely correlate with reflux severity.
- Dysfunctional voiding is a significant issue in younger children with VUR and LUTS.
- Treatment strategies for voiding dysfunction in VUR patients should be individualized based on specific urodynamic abnormalities.
Purpose:
We investigated associated urodynamic abnormalities in toilet trained children with vesicoureteral reflux.
Materials And Methods:
A total of 298 toilet trained children with primary vesicoureteral reflux underwent urodynamic evaluation. Urodynamic parameters were reviewed and correlated with age, gender, presence of lower urinary tract symptoms and reflux severity.
Results:
Symptomatic lower urinary tract symptoms were present in 111 children (37.2%, group 1). Children with lower urinary tract symptoms had significantly decreased severity of vesicoureteral reflux compared to children without these symptoms (187 patients, group 2). The majority of the patients had normal early bladder compliance regardless of presence of lower urinary tract symptoms or reflux grade. On the other hand, decreased late bladder compliance was more common in group 1 vs group 2. Ratio of cystometric bladder capacity to expected bladder capacity was higher in group 2. Detrusor overactivity was observed in 28.5% of the children, and the incidence was significantly higher in group 1 vs group 2, and in mild vs moderate or severe reflux. Dysfunctional voiding from bladder sphincter dyscoordination was seen in 32% of children 2.5 to 4 years old with vesicoureteral reflux and lower urinary tract symptoms, compared to 8% in children 5 to 16 years old.
Conclusions:
The presence of lower urinary tract symptoms in children with vesicoureteral reflux correlated well with some urodynamic findings suggestive of overactive bladder and negatively correlated with reflux severity. In contrast, dysfunctional voiding was more common in younger children with reflux and lower urinary tract symptoms. These findings suggest that treatment of voiding dysfunction should be directed toward the specific type of abnormality in children with vesicoureteral reflux.
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