title: Urodynamic abnormalities in toilet trained children with primary vesicoureteral reflux.
abstract: OBJECTIVE
  We investigated associated urodynamic abnormalities in toilet trained children with vesicoureteral reflux.
  
  
  METHODS
  A total of 298 toilet trained children with primary vesicoureteral reflux underwent urodynamic evaluation. Urodynamic parameters were reviewed and correlated with age, gender, presence of lower urinary tract symptoms and reflux severity.
  
  
  RESULTS
  Symptomatic lower urinary tract symptoms were present in 111 children (37.2%, group 1). Children with lower urinary tract symptoms had significantly decreased severity of vesicoureteral reflux compared to children without these symptoms (187 patients, group 2). The majority of the patients had normal early bladder compliance regardless of presence of lower urinary tract symptoms or reflux grade. On the other hand, decreased late bladder compliance was more common in group 1 vs group 2. Ratio of cystometric bladder capacity to expected bladder capacity was higher in group 2. Detrusor overactivity was observed in 28.5% of the children, and the incidence was significantly higher in group 1 vs group 2, and in mild vs moderate or severe reflux. Dysfunctional voiding from bladder sphincter dyscoordination was seen in 32% of children 2.5 to 4 years old with vesicoureteral reflux and lower urinary tract symptoms, compared to 8% in children 5 to 16 years old.
  
  
  CONCLUSIONS
  The presence of lower urinary tract symptoms in children with vesicoureteral reflux correlated well with some urodynamic findings suggestive of overactive bladder and negatively correlated with reflux severity. In contrast, dysfunctional voiding was more common in younger children with reflux and lower urinary tract symptoms. These findings suggest that treatment of voiding dysfunction should be directed toward the specific type of abnormality in children with vesicoureteral reflux.
authors.affiliation: Department of Urology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Young Kwon
authors.initials: YK
authors.lastname: Hong
authors.forename: Emanuela
authors.initials: E
authors.lastname: Altobelli
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Borer
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Bauer
authors.forename: Hiep T
authors.initials: HT
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012720:Severity of Illness Index; D014039:Toilet Training; D001743:Urinary Bladder / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000503:physiopathology*; D014555:Urination Disorders / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology*; D014718:Vesico-Ureteral Reflux / Q000503:physiopathology*