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Published on: August 14, 2019
Can we predict vesicoureteral reflux resolution in patients with non-neurogenic lower urinary tract dysfunction?
Ozgur Cakmak1, Huseyin Tarhan2, Ilker Akarken2
1Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
Insights
Low post-void residual urine volume and a low Dysfunctional Voiding and Incontinence Symptom Score predict spontaneous resolution of vesicoureteral reflux in children with lower urinary tract dysfunction.
Area of Science:
- Pediatric Urology
- Nephrology
- Pediatric Lower Urinary Tract Dysfunction
Background:
- Vesicoureteral reflux (VUR) often coexists with non-neurogenic lower urinary tract dysfunction (NLUTD) in children.
- Understanding factors predicting spontaneous VUR resolution is crucial for management.
- NLUTD can complicate VUR treatment and prognosis.
Purpose of the Study:
- To identify clinical and urodynamic factors associated with spontaneous resolution of VUR in children with NLUTD.
- To analyze the impact of voiding dysfunction on VUR outcomes.
- To guide therapeutic strategies for pediatric VUR and NLUTD.
Main Methods:
- Retrospective analysis of 98 children with VUR and NLUTD.
- Exclusion of patients with neurogenic conditions, anatomical malformations, or prior VUR surgery.
- Evaluation of medical history, physical exam, urinalysis, uroflowmetry with EMG, ultrasonography, and the Dysfunctional Voiding and Incontinence Symptom Score (DVISS) questionnaire.
Main Results:
- Significant differences between resolution and non-resolution groups included DVISS, bladder wall thickness, and post-void residual urine volume (PVR).
- Higher frequency, urgency, and daytime incontinence were observed in the non-resolution group.
- Multivariate analysis identified PVR and DVISS as significant predictors of VUR resolution (P=0.002 for both).
Conclusions:
- Absence of significant PVR and a low DVISS are associated with increased likelihood of spontaneous VUR resolution.
- These factors can help predict VUR outcomes in children with NLUTD.
- Optimizing bladder emptying and managing voiding dysfunction may improve VUR resolution rates.
Objective:
To analyze factors influencing reflux resolution in patients with the coexistence of non-neurogenic lower urinary tract dysfunction and vesicoureteral reflux.
Methods:
The data of 153 children who were diagnosed with vesicoureteral reflux and accompanying non-neurogenic lower urinary tract dysfunction between 2010 and 2015 were retrospectively evaluated. Patients with neurogenic and anatomical malformations, monosymptomatic nocturnal enuresis, previous history of vesicoureteral reflux surgery, irregular and/or incomplete follow-up data were excluded. After exclusion of 55 patients, 98 patients were enrolled in this study. Patients were divided into two groups according to the presence of spontaneous vesicoureteral reflux resolution during the follow-up period. Group 1 consisted of 54 children with spontaneous vesicoureteral reflux resolution, whereas group 2 included 44 children without resolution. Medical history, physical examination, urinalysis, uroflowmetry combined with electromyography, ultrasonography, as well as the Dysfunctional Voiding and Incontinence Symptom Score questionnaire were also evaluated.
Results:
The mean age at presentation was 7.57 ± 0.23 years (range 5-13 years), and the mean follow-up period was 28.3 months. Significant differences were noted between the two groups in terms of dysfunctional voiding and incontinence symptom score, bladder wall thickness, and the post-void residual urine volumes. In addition, lower urinary tract symptoms, namely frequency, urgency and daytime incontinence, were found to be higher in group 2. In multivariate analysis, post-void residual urine volume and Dysfunctional Voiding and Incontinence Symptom Score were found to affect reflux resolution rates (P = 0.002, P = 0.002, respectively).
Conclusions:
The absence of significant post-void residual urine volume, and a low Dysfunctional Voiding and Incontinence Symptom Score increase the likelihood of spontaneous resolution rates of vesicoureteral reflux in children with non-neurogenic lower urinary tract dysfunction.
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