Table of Contents

HK J Paediatr (New Series)
Vol 2. No. 2, 1997

HK J Paediatr (New Series) 1997;2:176

Proceedings of Scientific Meeting

The Changes in Bladder Functional Status is An Important Predictive Indicator for the Natural Outcome of Primary Vescicoureteric Reflux During the First Two Years of Life

CK Yeung

HK J Paediatr (new series) 1997;2:175-186

Hong Kong Paediatric Society 35th Anniversary Scientific Meeting September 6,1997

Objectives : To evaluate the relationship between the changes in bladder functional status from early infancy to the second year of life with the clinical outcome of reflux in infants with significant primary VUR (grade III or higher).

Methods : Thirty patients (26 boys, 4 girls) with 52 reflux units diagnosed before 6 months of age were treated conservatively with prophylactic antibiotics. Prolonged natural filling cystometry was performed soon after diagnosis before 6 months and then repeated at around 15 months of age. A direct isotope cystogram was performed at 15 months to determine the outcome of reflux and this was correlated with the evolution in bladder functional status as evidenced by the paired cystometric studies. Results: -VUR persisted in 19 patients (32 reflux units). Persistence of reflux was closely related to the presence of bladder dysfunction, especially detrusor instability and inadequate emptying. Of 14 infants (21 reflux units at 6 months) who had either a normal or a normal/immature bladder functional pattern at 15 months, reflux resolved spontaneously in 16 units (76%). In contrast, of 16 infants (31 reflux units at 6 months) who had either dyssynergic, unstable, inadequate or obstructive bladders, reflux disappeared in only 4 units (13%, p < 0.001). In general, voiding pressures recorded during the 15-month studies were significantly lower compared with those recorded in the early studies, especially for infants with normal/hypercontractile, immature and dyssynergic bladders. Of note, 3 of 7 infants with a dyssynergic bladder at 6 months developed an inadequate bladder functional pattern with a significant decrease in detrusor contractility and increase in bladder capacity at 15 months. Thirteen infants (25 reflux units at 6 months) had abnormal bladder function demonstrated by both cystometric studies, and reflux persisted in all of them (only 1 reflux unit resolved).

Conclusions : There is a strong correlation between the bladder functional status and the early outcome of reflux. Detrusor hypercontractility documented in early infancy may either normalize or progress into bladder decompensation with inadequate emptying in the second year of life. These may have very important implications on our current concepts about the pathogenesis and management of high grade 'primary' VUR in infancy.


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