Vesicoureteric reflux in children with urodynamic dysfunctions

The aim of the study is to determine the incidence of vesicoureteric reflux (VUR) in children with various urodynamic dysfunctions and to analyse the relation between the type of the urodynamic dysfunction and the degree of VUR. We analysed 127 children who underwent urodynamic study after voiding cystourethrography. Indications for urodynamic study were: urinary incontinence, recurrent urinary tract infections despite antibiotic prophylaxis, vesicoureteric reflux after the second year of age, voiding dysfunction such as increased urinary frequency, infrequent voiding, hesitancy and straining during voiding. Vesicoureteric reflux was observed in 39 children (31%). Seven (16.2%) children had normal urodynamic findings, 15 (30.6%) had an unstable bladder, and 17 (58.6%) had dysfunctional voiding. In children with unstable bladder unilateral reflux (67%) and low-grade reflux (I-II) (90%) were more common. In children with dysfunctional voiding bilateral VUR (53%) was more common, and high-grade reflux (III-IV) was observed in 42% of children. In children without incontinence or other clinical symptoms suggestive of bladder dysfunction, in whom the main indication for urodynamic investigation was VUR after the second year of age, normal urodynamic findings were observed in only six children (25%). Vesicoureteric reflux was observed in about 30% of children with urodynamic dysfunction. In children with an unstable bladder, unilateral and low grade VUR is more common. In children with more severe urodynamic disorders, with obstruction during micturition, reflux is mostly high grade and often bilateral. These findings confirm that the obstruction in the phase of micturition causes more severe anatomic alterations of the bladder wall and vesicoureteric junction, as compared to the obstruction in the filling phase of the unstable bladder. Even 30 to 40% of children with urodynamic dysfunction do not have clinical symptoms of urge, incontinence, or other voiding problems that would suggest dysfunction. So, in children with vesicoureteric reflux after second year of age, urodynamic study should be performed in order to exclude lower urinary tract dysfunction. The therapy of vesicoureteric reflux should be planned according to the urodynamic study finding.