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Published on: October 12, 2017
Vesicoureteral reflux and urodynamic dysfunction
Danica Batinic1, Danko Miloševic, Marija Topalovic-Grkovic
1Nephrology Department, University Children's Hospital, Clinical Hospital Center, Zagreb, Croatia. danka.batinic@zg.t-com.hr
Insights
Vesicoureteral reflux (VUR) in children is often linked to lower urinary tract dysfunction, leading to high bladder pressure. This study found that most children with VUR have abnormal urodynamics, particularly overactive bladder or dysfunctional voiding.
Area of Science:
- Pediatric Urology
- Urodynamics
- Lower Urinary Tract Dysfunction
Background:
- Vesicoureteral reflux (VUR) is increasingly recognized as associated with lower urinary tract dysfunction (LUTD).
- LUTD can cause high intravesical pressure, predisposing children to VUR.
- This challenges the traditional view of VUR solely as a consequence of congenital anomalies.
Purpose of the Study:
- To investigate the urodynamic findings in children diagnosed with VUR.
- To determine the prevalence of lower urinary tract dysfunction in this pediatric population.
Main Methods:
- Urodynamic assessment using pressure-flow-EMG studies.
- Evaluated 132 children with VUR, analyzing 162 refluxing units.
- Classified VUR grades and correlated findings with age and presence of uroinfections.
Main Results:
- A significant majority (75%) of children with VUR exhibited abnormal urodynamic findings.
- Overactive bladder (OAB) was the most common abnormality (44.7%), followed by dysfunctional voiding (DV) (18.9%).
- Lower VUR grades (I and II) were associated with a higher incidence of pathological urodynamics, particularly OAB in younger children.
Conclusions:
- Pediatric VUR frequently coexists with significant urodynamic disorders.
- Urodynamic dysfunction likely plays a role in the pathogenesis of VUR, especially in milder forms.
- Identifying and managing LUTD is crucial in children with VUR.
Introduction:
The concept of vesicoureteral reflux (VUR) as a consequence of congenital anomaly of vesicoureteral junction has undergone changes owing to the finding that such children may have lower urinary tract dysfunction, which produces high intravesical pressure and consequently a predisposition for VUR.
Patients And Methods:
The urodynamics was investigated by pressure-flow-EMG study in 132 children with VUR and 162 refluxing units.
Results:
Only 33 (25.0%) patients had normal urodynamic finding. The most frequent pathological finding was overactive bladder (OAB), found in 59 (44.7%) children, followed by dysfunctional voiding (DV) in 25 (18.9%) children. Children with VUR grades I and II had a higher percentage of pathological urodynamic findings than children with VUR grades III and IV. OAB was more frequent in children under 5 years of age with unilateral and lower grade VUR. It was found equally in children with and without uroinfections. DV was more frequent in children older than 5 years, with bilateral VUR, higher grade VUR and uroinfections.
Conclusions:
Children with VUR have a high incidence of urodynamic disorders. The results of the study indicate the possible role of urodynamic dysfunction in the pathogenesis of VUR, especially mild one.
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