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Is there any role for urodynamic study in children with high-grade vesicoureteral reflux?
Hossein Karami1, Abdollah Razi, Mohammad Mohsen Mazloomfard
1Urology and Nephrology Research Center (UNRC), Shohada Medical Center, Shaheed Beheshti Medical University, Tehran, Islamic Republic of Iran. info@drhosseinkarami.com
Insights
Children with high-grade vesicoureteral reflux (VUR) often have overactive bladders and high filling pressures. These urodynamic issues may be the primary cause of VUR, highlighting the importance of proper management to protect kidney function.
Area of Science:
- Pediatric Urology
- Nephrology
- Urodynamics
Background:
- Vesicoureteral reflux (VUR) in children can lead to kidney damage if not managed properly.
- Understanding the clinical and urodynamic features of high-grade VUR is crucial for effective treatment.
Purpose of the Study:
- To investigate the clinical symptoms and urodynamic characteristics in children diagnosed with primary high-grade VUR.
- To explore potential causal links between urodynamic abnormalities and the occurrence of high-grade VUR.
Main Methods:
- A prospective study involving 147 children (≤12 years) with idiopathic high-grade VUR.
- Assessment included detailed clinical symptom evaluation and comprehensive urodynamic parameter analysis.
Main Results:
- Recurrent urinary tract infections (57%) and urgency (59%) were the most prevalent symptoms.
- Abnormal urodynamics were common, with overactive bladder (74%), high-end filling pressure (72.7%), and low bladder compliance (56%) being most frequent.
- Only 23% of patients presented with normal urodynamic findings.
Conclusions:
- High-grade VUR in children is frequently associated with significant urodynamic abnormalities, particularly overactive bladder and high filling pressures.
- These urodynamic findings suggest they may be a fundamental cause of high-grade VUR in pediatric patients.
- Effective management of VUR is essential to prevent adverse effects on renal function.
Objective:
To determine the clinical symptoms and urodynamic characteristics among children with primary high-grade vesicoureteral reflux (VUR).
Materials And Methods:
We prospectively studied clinical symptoms and urodynamic parameters in 147 consecutive patients ≤ 12 years old with idiopathic high-grade VUR referred to our hospital.
Results:
Of 147 patients with high-grade VUR, 139 cases with mean age of 5.3 years met our inclusion criteria (88.5% females, 11.5% males). The most common symptom was recurrent urinary tract infection (57%) and urgency (59%) followed by enuresis (31.6%) and frequency (26.6%). Normal urodynamic findings were observed in 23% of patients. Overactive bladder (74%), high-end filling pressure (72.7%), low-compliance bladder (56%), and low bladder capacity (51%) were the most common urodynamic reports in this study. Other urodynamic findings were underactive bladder (1.5%), hypersensitive bladder (1.5%), hyposensitive bladder (3%), and high capacity bladder (2.2%).
Conclusion:
Proper management of VUR is very important because of its harmful potential effects on kidney function in children. With regard to the issue that most children with grade III and higher VUR had overactive bladder, high-end filling pressure, and other urodynamic disorders in their urodynamic study, it seems that these urodynamic disorders could be the basic cause of reflux.
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