Influence of high bladder pressure on vesicoureteral reflux and its resolution.

OBJECTIVES: Voiding dysfunction may result in lower urinary tract symptoms in children and is associated with urinary tract infection, renal damage and vesicoureteral reflux (VUR). The aim of this study was to assess the relationship between detrusor pressure, VUR and abnormal renal scintigraphy findings in children with dysfunctional voiding.

PATIENTS AND METHODS: Between 2004 and 2007, 30 children with VUR and voiding dysfunction, 22 girls and 8 boys, median age 8.2 years, were evaluated. Urodynamic study, renal scan and voiding cystourethrography were performed in all patients.

RESULTS: The degree of the renal scarring was found to be associated with the detrusor pressures (p = 0.018). The highest detrusor pressure was shown in the group of urge syndrome. The degree of the VUR was found to be correlated with the detrusor pressures (p = 0.038). In our study group, VUR had resolved in 11 (37%) patients, had improved in grade in 10 (33%) patients and remained unchanged in 9 (30%) patients after anticholinergic therapy. No significant relationship was found between the duration of therapy and the voiding patterns (p = 0.389).

CONCLUSION: Every child with VUR should undergo a careful evaluation of its bladder function. The patients who have high detrusor pressures should be evaluated carefully for the presence of VUR and renal damage.