Lower urinary tract function in vesicoureteral reflux

Sixty patients with vesico-ureteral reflux underwent a thorough urodynamic investigation including multiple spontaneous voidings, a combined video voiding cystourethrography, cystometry and pressure flow study via suprapubic catheters. A final urodynamic assessment was derived from the compiled information with respect to the consistency of the findings. We chose the least abnormal finding. Stable bladder was diagnosed in 23 patients while 33 had various degrees of instability. The incidence of bladder instability showed a tendency to a decrease with age from 67% among children aged 2-6 years to 50% in the age group 12-16 years. Voiding was normal in 52 patients. Six patients showed consistent urethral overactivity and one patient had signs of minor infravesical obstruction. Patients with normal urodynamics showed a significantly lower incidence of nephropathy compared to those with pathological urodynamics although the prevalence and the degree of reflux were equally distributed over the whole material. A significant correlation was seen between the severeness of bladder instability and reflux nephropathy in high grade reflux (grade III or more). Consistent urethral overactivity did not influence the incidence of reflux and reflux nephropathy. The study underlines the relationship between abnormal bladder activity and reflux nephropathy.