Video-Urodynamic Study in Children with Vesicoureteral Reflux and Voiding Dysfunction

Kim, Kwang Myung; Park, Kwan Hyun; Choi, Hwang

Abstract

PURPOSE
Voiding dysfunction is known to affect on the result of treatment for vesicoureteral reflux(VUR) in children. The aim of this study is to find out specific urodynamic abnormality in the children with VUR and voiding dysfunction.
MATERIALS AND METHODS
We evaluated 16 children having VUR with voiding dysfunction symptoms. Voiding symptoms were frequency, urgency, urge incontinence, nocturnal enuresis and voiding postponement. An awake video-urodynamic study(video-UDS) was performed without anesthesia.
RESULTS
Urodynamic abnormalities were found in 11 children(69%). The most common urodynamic abnormality was uninhibited detrusor contraction(10 cases, 63%), and 8 of these patients had urgency and/or urge incontinence. Other urodynamic abnormalities were small maximum cystometric capacity(5 cases, 31%), and detrusor sphincter dyssynergia(DSD)(3 cases, 19%). All the children with DSD had voiding postponement. VUR was found in 8 children(50%) during video-UDS. Among the urodynamic parameters small cystometric bladder capacity was found to be a most significant factor in predicting low Pressure VUR(sensitivity 100%, specificity 100%, p=0.018).
CONCLUSIONS
These results suggest that abnormal detrusor activity is more frequent than abnormal coordination between detrusor and external sphincter activity in the children with VUR and voiding dysfunction symptoms. And small maximum cystometric capacity seems to be a significant urodynamic parameter for perpetuating VUR in these children.