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The Swedish Infant High-grade Reflux Trial - Bladder function.

J Nordenström1, U Sillen1, G Holmdahl1

  • 1Department of Pediatric Surgery, The Pediatric Uronephrologic Centre, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.

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|December 20, 2016
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Summary
This summary is machine-generated.

Early resolution of high-grade vesicoureteral reflux (VUR) does not prevent lower urinary tract dysfunction (LUTD). High post-void residual (PVR) at baseline predicts non-resolution of VUR and recurrent urinary tract infections, indicating LUTD is a prognostic factor.

Keywords:
Bladder capacityFree voiding observationInfantsLower urinary tract dysfunctionResidual urineVesicoureteral reflux

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Area of Science:

  • Pediatric Urology
  • Nephrology
  • Pediatric Surgery

Background:

  • Infants with high-grade vesicoureteral reflux (VUR) are sometimes associated with lower urinary tract dysfunction (LUTD), characterized by large bladder capacity (BC) and increased post-void residual (PVR).
  • However, many infants present with normal or small BC, developing larger capacity within the first year of life.

Purpose of the Study:

  • To investigate if early resolution of high-grade VUR can prevent the development of LUTD in infants.
  • To assess the relationship between VUR grade, bladder function, and treatment outcomes.

Main Methods:

  • A randomized trial involving 77 infants (<8 months) with VUR grade 4-5, comparing antibiotic prophylaxis (n=39) with endoscopic treatment (ET) (n=38).
  • Bladder capacity (BC) and post-void residual (PVR) were assessed using free voiding observation (FVO) at baseline and 1 year.
  • LUTD was defined as BC ≥150% of expected and PVR ≥20 ml.

Main Results:

  • No significant differences in bladder function were observed between the antibiotic and ET groups, despite differences in VUR resolution.
  • VUR grade ≤2 at 1 year was associated with smaller BC and lower baseline PVR.
  • Persistent bilateral grade 5 VUR at 1 year correlated with larger BC, higher PVR, and more LUTD at baseline and 1 year.
  • High baseline PVR predicted non-resolution of high-grade VUR, recurrent UTIs, and showed a tendency towards new renal damage.

Conclusions:

  • Early VUR resolution did not prevent LUTD development.
  • In infants with VUR resolution, BC decreased while PVR increased.
  • High baseline PVR is a significant predictor of VUR non-resolution and recurrent UTIs, suggesting LUTD is a prognostic factor for VUR outcomes.