Bladder Dysfunction in Children with Primary Vesicoureteral Reflux: Do We Need to Change Indications for Surgery?

Vesicoureteral reflux (VUR) is commonly seen in children. However, in Indian literature, not much has been discussed about bladder dysfunction (BD) in VUR. The present study aims to study BD in children with primary VUR.

In this prospective study, 86 children with primary VUR were enrolled over a 2-year duration with at least 1 year of follow-up. BD was studied using noninvasive (history, ultrasound kidney ureter bladder, and Dysfunctional Voiding Scoring System) and invasive (urodynamic study [UDS]) methods and was classified into (1) underactive bladder, (2) overactive bladder (OAB), and (3) significant postvoid residue (PVR) in those who underwent UDS. Those who underwent surgery were followed up and assessed for improvement in BD.

Overall incidence of BD in cases of primary VUR was 41.8% (n = 36). Among toilet-trained children (n = 48), 30 underwent UDS, and 18 (60%) were found to have BD. In 18 cases where UDS was not possible, 10 (55.5%) had BD. In nontoilet-trained children (n = 38), 8 out of 38 (21%) had BD. Among those with BD (n = 36), 21 (58%) patients underwent surgery for VUR. Improvement in bladder function was observed in 18 out of the 21 patients (85.7%) postsurgery. Among the toilet-trained children where UDS could be done, improvement was found in 66.6% of cases (n = 6), while improvement was seen in 100% of cases (n = 9), where UDS could not be done. In nontoilet-trained children, improvement was seen in 100% of cases (n = 3).

BD has a potential role in defining indications for surgery in VUR. Objective assessment of BD by UDS is accurate, but it cannot be used in nontoilet-trained children. Underactive bladders and patients with significant PVR need early surgical intervention. OABs need pharmacological intervention to increase bladder capacity and decrease the bladder pressures before surgery can be advised.