Enuresis as protective factor in vesicoureteral reflux

In 83 patients with non-neurologic, nonoperated vesicoureteral reflux the relation between enuresis and nephropathy was analyzed. The material showed that in spite of identical age, sex distribution, previous history of recurrent urinary tract infections, and the number of refluxing units, patients with enuresis showed a significantly lower degree of reflux nephropathy. This significant difference was even more pronounced when the age of the patients was considered. Thus patients below the age of ten showed reflux nephropathy in 25 per cent of the refluxing units in enuretic patients compared with 30.8 per cent in the nonenuretic patients. Above the age of ten 76.2 per cent of the refluxing units showed renal scarring in the nonenuretics compared with 27.8 per cent in the enuretics. The study stresses the importance of lower urinary tract malfunction in the pathogenesis of reflux. Enuresis might act as a safety valve mechanism reducing the possibility of reflux nephropathy.