title: Outcomes of targeted treatment for vesicoureteral reflux in children with nonneurogenic lower urinary tract dysfunction.
abstract: OBJECTIVE
  There is a known association between nonneurogenic lower urinary tract conditions and vesicoureteral reflux. Whether reflux is secondary to the lower urinary tract condition or coincidental is controversial. We determined the rate of reflux resolution in patients with lower urinary tract dysfunction using targeted treatment for the underlying condition.
  
  
  METHODS
  Patients diagnosed and treated for a lower urinary tract condition who had concomitant vesicoureteral reflux at or near the time of diagnosis were included. Patients underwent targeted treatment and antibiotic prophylaxis, and reflux was monitored with voiding cystourethrography or videourodynamics.
  
  
  RESULTS
  Vesicoureteral reflux was identified in 58 ureters in 36 females and 5 males with a mean age of 6.2 years. After a mean of 3.1 years of treatment reflux resolved with targeted treatment in 26 of 58 ureters (45%). All of these patients had a history of urinary tract infections before starting targeted treatment. Resolution rates of vesicoureteral reflux were similar for all reflux grades. Resolution or significant improvement of reflux was greater in the ureters of patients with dysfunctional voiding (70%) compared to those with idiopathic detrusor overactivity disorder (38%) or detrusor underutilization (40%).
  
  
  CONCLUSIONS
  Vesicoureteral reflux associated with lower urinary tract conditions resolved with targeted treatment and antibiotic prophylaxis in 45% of ureters. Unlike the resolution rates reported in patients with reflux without a coexisting lower urinary tract condition, we found that there were no differences in resolution rates among grades I to V reflux in patients with lower urinary tract conditions. Patients with dysfunctional voiding had the most improvement and greatest resolution of reflux. Additionally grade V reflux resolved in some patients.
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Fast
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Nees
authors.forename: Jason P
authors.initials: JP
authors.lastname: Van Batavia
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Combs
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Glassberg
mesh_terms: D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual; D016503:Drug Delivery Systems / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy; D014555:Urination Disorders / Q000175:diagnosis / Q000188:drug therapy; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D018680:Cholinergic Antagonists
keywords: AUA; American Urological Association; BBD; DUD; DV; EMG; ICCS; IDOD; International Children's Continence Society; LUT; PBND; TT; UTI; VCUG; VUR; bowel and bladder dysfunction; detrusor underutilization disorder; dysfunctional voiding; electromyography; idiopathic detrusor overactivity disorder; lower urinary tract; lower urinary tract symptoms; pediatrics; primary bladder neck dysfunction; targeted treatment; urinary tract infection; urination disorders; vesico-ureteral reflux; vesicoureteral reflux; voiding cystourethrography