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Vesicoureteral reflux and lower urinary tract dysfunction: evidence for 2 different reflux/dysfunction complexes
Insights
This study found two distinct types of lower urinary tract dysfunction associated with vesicoureteral reflux in children. These types differ in bladder function, reflux sideality, and the likelihood of kidney damage.
Area of Science:
- Pediatric Urology
- Nephrology
- Urodynamics
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- The relationship between lower urinary tract dysfunction (LUTD) and VUR requires further elucidation.
- Understanding these associations is crucial for predicting outcomes and guiding treatment.
Purpose of the Study:
- To investigate the association between LUTD and VUR in children.
- To identify distinct patterns or subtypes of VUR associated with specific types of LUTD.
- To characterize the urodynamic profiles and clinical implications of these VUR/LUTD complexes.
Main Methods:
- Retrospective analysis of 458 children aged 2-15 years without neurological or anatomical abnormalities.
- Videourodynamic studies to assess bladder and urethral function during voiding.
- Classification of VUR/LUTD complexes based on urodynamic findings and reflux characteristics.
Main Results:
- Two distinct VUR/LUTD complexes were identified with contrasting urodynamic features.
- Type 1: Bladder instability with strong voiding contractions, unilateral reflux, and rare reflux nephropathy.
- Type 2: Poor bladder contractility, urethral overactivity, bilateral reflux, and common reflux nephropathy or upper tract abnormalities.
Conclusions:
- LUTD and VUR in children present as at least two distinct pathophysiological entities.
- These subtypes have different urodynamic characteristics and varying risks of renal damage.
- Videourodynamic assessment is key to differentiating these complexes and informing prognosis.
Abstract:
We examined retrospectively 458 children 2 to 15 years old without neuropathic conditions or a gross anatomical abnormality to determine whether there was an association between lower urinary tract dysfunction and vesicoureteral reflux. We identified 2 different types of reflux/dysfunction complexes with contrasting urodynamic characteristics. One type included bladder instability with powerful voiding contractions of the bladder and reflux that frequently occurred on 1 side only. Reflux nephropathy or the presence of an upper urinary tract abnormality is rare. In the other type the bladder contracted poorly during voiding and overactivity of the urethral closure mechanism often was observed. The bladder usually was stable and the reflux occurred frequently on both sides. Reflux nephropathy or the presence of an upper urinary tract abnormality is relatively common. Direct videourodynamic observations of reflux in a second group of children confirmed the existence of these 2 types of reflux/dysfunction complexes.