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Updated: Jan 20, 2026
An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
Bladder/bowel dysfunction at school age is seen in children with high-grade vesicoureteral reflux and lower urinary
Sofia Sjöström1, Helena Ekdahl1, Kate Abrahamsson1
1The Pediatric UroNephrologic Centre, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
Insights
Most children with congenital high-grade vesicoureteral reflux (VUR) and lower urinary tract dysfunction (LUTD) show bladder/bowel dysfunction at school age. Early intervention may improve long-term bladder function outcomes.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Pediatric Surgery
Background:
- Congenital high-grade vesicoureteral reflux (VUR) often co-occurs with lower urinary tract dysfunction (LUTD) in infants.
- LUTD presents as a high-capacity bladder and incomplete emptying.
- Previous studies treated these infants with clean intermittent catheterization and VUR surgery.
Purpose of the Study:
- To evaluate the long-term bladder function in children previously diagnosed with high-grade VUR and LUTD.
- To assess the effectiveness of early intervention on bladder function at school age.
Main Methods:
- Bladder function was assessed in 20 children at a mean age of 7.3 years.
- Evaluations included a validated voiding-bowel questionnaire and a urine flow/residual study.
Main Results:
- The majority of children (80%) exhibited bladder/bowel dysfunction at follow-up.
- 55% had clear bladder/bowel dysfunction (scores 7-19), and 25% had mild dysfunction (score 6).
- Recurrent febrile urinary tract infections correlated with fecal question scores.
Conclusions:
- Children with high-grade VUR and LUTD in infancy often present with varying degrees of bladder/bowel dysfunction at school age.
- The findings highlight the persistent nature of bladder dysfunction in this cohort.
- Further research into long-term management strategies is warranted.
Aim:
In approximately one third of cases, congenital high-grade vesicoureteral reflux (VUR) diagnosed during infancy is seen together with lower urinary tract dysfunction (LUTD), characterised by a high-capacity bladder and incomplete emptying. In an earlier study, 20 of these infants were treated with clean intermittent catheterisation during a 3-year period and with surgical treatment of the VUR before catheterisation was ended. In the present study, bladder function was evaluated in these children at school age.
Methods:
Bladder function was evaluated in the 20 children at a mean age of 7.3 years using a validated voiding-bowel questionnaire with scores (cut-off score 7) and a urine flow/residual study.
Results:
Four children (20%) had a normal voiding function at follow-up, whereas 11 (55%) had a clear bladder/bowel dysfunction (scores 7-19) and five (25%) had a mild dysfunction (score 6). Ten (63%) of the children with any dysfunction were recognised as dysfunctional voiding. Recurrent febrile urinary tract infections were correlated with the scores of faecal questions (P = .041), but for total scores P = .058.
Conclusion:
The follow-up of bladder function in children at 7.3 years, diagnosed with high-grade VUR and LUTD in infancy, revealed bladder/bowel dysfunction of varying severity in the majority of cases.
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