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Vesicoureteral reflux and lower urinary tract dysfunction: evidence for 2 different reflux/dysfunction complexes.

D J Griffiths, R J Scholtmeijer

    The Journal of Urology
    |February 1, 1987
    PubMed
    Summary

    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.

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    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.

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  • 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.