[Vesicoureteric reflux and functional voiding dysfunction in children].
OBJECTIVE
To analyze the efficacy of the different treatments of vesicoureteric reflux (VUR) associated with reflex bladder sphincter dyssynergia (RBSD).


METHODS
The medical records of 33 children (28 girls) aged 4 to 12 years presenting reflex bladder sphincter dyssynergia and vesicoureteric reflux have been reviewed. The most common clinical symptom was urinary tract infection. Voiding dysfunction included: dysuria, urinary leak, enuresia, urgency, constipation. In most cases, vesicoureteric reflux was low grade (grade 1, n=9; grade 2, n=18; grade 3, n=6) and bilateral (n=18). Three types of treatments have been utilized: reimplantation, reeducation, medical treatment (diet, antibio-prophylaxis, anti-cholinergics).


RESULTS
Eleven children (2 with a solitary kidney) underwent early reimplantation which was effective on vesicoureteric reflux but 6 of them had post-operative voiding dysfunction and 5 had a new episode of urinary infection. Six had reeducation first then they underwent reimplantation. Sixteen children had an exclusive medical treatment (13 with reeducation). In 9 children vesicoureteric reflux disappeared (one child still complains of voiding dysfunction). In 7, voiding dysfunction improved but vesicoureteric reflux is still present.


CONCLUSIONS
The management of vesicoureteric reflux associated with reflex bladder sphincter dyssynergia is complex. Surgery should certainly not be the initial treatment. However, it can remain useful if one wishes to get complete resolution of reflux.
Badachi
Y
Y
Services de Radiologie Centrale, CHU de Rouen.
Pietrera
P
P
Liard
A
A
Pfister
C
C
Dacher
J N
JN
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D018579:Patient Selection; D012092:Replantation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014039:Toilet Training; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014552:Urinary Tract Infections / Q000209:etiology*; D014555:Urination Disorders / Q000209:etiology*; D014563:Urodynamics; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
D000900:Anti-Bacterial Agents; D018680:Cholinergic Antagonists