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Radiological bladder characteristics in VCU for young children with high-grade VUR.

K Felberg1, U Sillén2, M Bachelard2

  • 1Pediatric Uronephrologic Center, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; The Children's Memorial Health Institute, Warsaw, Poland.

Journal of Pediatric Urology
|February 21, 2015
PubMed
Summary

Large bladder size on voiding cystourethrography (VCUG) indicates high bladder capacity and lower urinary tract (LUT) dysfunction in infants with vesicoureteral reflux (VUR). Overactive bladder contractions may also be identified on VCUG in infants.

Keywords:
InfantsLower urinary tract dysfunctionVCUGVesicoureteral reflux

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Area of Science:

  • Pediatric Urology
  • Radiology
  • Urodynamics

Background:

  • Infants with dilating vesicoureteral reflux (VUR) may exhibit lower urinary tract (LUT) dysfunction.
  • Traditional indicators of LUT dysfunction like high voiding pressure and low bladder capacity are not specific to infants.
  • Urodynamic findings of high bladder capacity with incomplete emptying and overactivity during filling are key for diagnosing LUT dysfunction in children with high-grade VUR.

Purpose of the Study:

  • To determine if cystometric signs of LUT dysfunction in infants with high-grade VUR can be identified through voiding cystourethrography (VCUG).
  • To evaluate the correlation between radiological signs on VCUG and urodynamic findings indicative of LUT dysfunction in infants.

Main Methods:

  • One hundred fifteen infants (80 boys) with Grades III-V VUR underwent repeated videocystometry (VCM) at 6, 21, and 39 months.
  • Bladder size (large, normal, small) was assessed on VCUG using pelvic landmarks and validated against healthy child data.
  • Abnormalities in bladder wall/form and posterior urethral filling without voiding were evaluated as signs of overactivity and dyscoordination.

Main Results:

  • Large bladder size on VCUG correlated significantly with higher cystometric capacity compared to healthy controls (P = 0.0001).
  • Small bladder size correlated with lower capacity (P = 0.011) and was often associated with bladder wall/shape pathology and overactive contractions.
  • Posterior urethral filling without voiding, indicating detrusor-sphincter dyscoordination, was common in the first year but decreased over time.

Conclusions:

  • A large bladder on VCUG in infants with high-grade VUR signifies a high-capacity bladder and potential LUT dysfunction, warranting further bladder function studies.
  • Overactive bladder contractions can be recognized on infant VCUG, serving as an indicator of LUT dysfunction.
  • Other VCUG signs observed in early infancy likely represent immature bladder function rather than VUR-related dysfunction.