J Willemsen1, R J Nijman. 1. Department of Paediatric Urology, Erasmus University Rotterdam, Sophia Children's Hospital, Rotterdam, The Netherlands.
Abstract
OBJECTIVES: To study the influence of bladder instability on the conservative management and surgical treatment of children with vesicoureteral reflux (VUR), 102 children were included in a prospective study. METHODS: During a 5-year period all children suspected to have VUR underwent a videourodynamic study to determine VUR grade and bladder function. This resulted in a group of 36 boys and 66 girls who were followed up for well over 5 years. RESULTS: Bladder instability was found in 41 of 102 children (40%). The 102 children were either treated conservatively or surgically. Of the 77 children who were treated conservatively, bladder instability was found in 35 patients. In the conservatively treated group with bladder instability, reflux resolved in 57%; whereas in those with normal bladder function, reflux resolved in 67%. Of the 25 patients who were treated surgically, the operation was successful in 91%. Breakthrough infections occurred in 22 girls and 3 boys, including 14 of 41 patients with bladder instability (34%) and 11 of 61 patients with normal bladder function (18%). CONCLUSIONS: Bladder instability is a frequent finding and an important factor in the treatment of children with VUR. To determine if a patient has VUR and bladder instability a videourodynamic study has proved to be an easy and efficient diagnostic tool. When bladder instability is treated with anticholinergic medication, almost the same results can be expected from conservative treatment as from surgical treatment compared to children with a normal bladder function. Breakthrough urinary tract infections occur more often in girls and tend to occur more often in children with bladder instability.
OBJECTIVES: To study the influence of bladder instability on the conservative management and surgical treatment of children with vesicoureteral reflux (VUR), 102 children were included in a prospective study. METHODS: During a 5-year period all children suspected to have VUR underwent a videourodynamic study to determine VUR grade and bladder function. This resulted in a group of 36 boys and 66 girls who were followed up for well over 5 years. RESULTS: Bladder instability was found in 41 of 102 children (40%). The 102 children were either treated conservatively or surgically. Of the 77 children who were treated conservatively, bladder instability was found in 35 patients. In the conservatively treated group with bladder instability, reflux resolved in 57%; whereas in those with normal bladder function, reflux resolved in 67%. Of the 25 patients who were treated surgically, the operation was successful in 91%. Breakthrough infections occurred in 22 girls and 3 boys, including 14 of 41 patients with bladder instability (34%) and 11 of 61 patients with normal bladder function (18%). CONCLUSIONS: Bladder instability is a frequent finding and an important factor in the treatment of children with VUR. To determine if a patient has VUR and bladder instability a videourodynamic study has proved to be an easy and efficient diagnostic tool. When bladder instability is treated with anticholinergic medication, almost the same results can be expected from conservative treatment as from surgical treatment compared to children with a normal bladder function. Breakthrough urinary tract infections occur more often in girls and tend to occur more often in children with bladder instability.
Authors: Russell W Chesney; Myra A Carpenter; Marva Moxey-Mims; Leroy Nyberg; Saul P Greenfield; Alejandro Hoberman; Ron Keren; Ron Matthews; Tej K Matoo Journal: Pediatrics Date: 2008-12 Impact factor: 7.124