Summary
Introduction
Vesicoureteral reflux (VUR) is a complex disease as patient spectrum is variable.
Some cases struggle with recurrent febrile urinary tract infections (UTI) and end-up
with renal scars despite intervention. While others suffer no clinical problems and
need no treatment. The detrimental effect of VUR on kidneys depends on many factors
like grade of reflux, detrusor pressure, and presence of voiding dysfunction. The
adverse effects of sterile VUR on kidneys is still under discussion. Thus, we assessed
the impact of detrusor pressure at VUR onset on renal scarring in children with sterile
reflux.
Materials and methods
We retrospectively reviewed the five years follow-up data of 38 children who had unilateral
VUR without UTI under treatment. No febrile or afebrile UTIs were detected during
the follow-up in any children. All children were assessed with annual video-urodynamics
and renal scintigraphy for five consecutive years. The detrusor pressure at VUR onset,
grade of VUR, presence of involuntary detrusor contractions, bladder capacity and
the presence of renal scaring were recorded. All VURs were recorded during the voiding
phase and children with VUR during the filling phase were excluded from the study.
Results
In the first line of video-urodynamic studies, the mean detrusor pressure at VUR onset
was 24.3 ± 14.8 cm/H2O (median 34.5 cm/H2O, min: 6 - max: 47). There was no relation between boys and girls regarding median
detrusor pressure at VUR onset (p = 0.356). Eventually, 22 (57.9%) children developed
renal scars and ended up with surgery. There was no relation between scar development
and age at first presentation (p = 0.888) The cut-off value for detrusor pressure
at VUR onset was noted as 26 cm/H2O (AUC: 0.849 [p < 0.01], Figure). In children who developed renal scars eventually,
the median detrusor pressure at VUR onset was significantly higher (p < 0.01).
Discussion
The detrimental effect of VUR on kidneys is associated with recurrent infections,
bladder dysfunction, and detrusor pressure. Dispute over risk of renal scarring in
patients with sterile VUR still continues.
Conclusion
Children in whom VUR start at higher voiding pressures suffer more renal scars. The
threshold of voiding detrusor pressure for risky patients is identified as 26 cm/H2O. It is true that patients suffering recurrent febrile UTIs have higher risk of developing
renal scarring. However, the impact of sterile reflux should not be underestimated,
since renal scars due to sterile reflux may develop in patients under antibiotic prophylaxis.
Keywords
Abbreviations:
VUR (Vesicoureteral reflux), UTI (Urinary tract infection), DMSA (Dimercaptosuccinic acid), ROC (Receiver Operating Characteristics)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 22, 2022
Accepted:
September 18,
2022
Received in revised form:
July 18,
2022
Received:
January 5,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
