title: Vesico-ureteral reflux in women with idiopathic high-pressure detrusor overactivity: prevalence, bladder function, and effect on the upper urinary tract.
abstract: OBJECTIVE
  To assess the prevalence of vesico-ureteral reflux (VUR) and upper urinary tract damage in women with idiopathic high-pressure detrusor overactivity (IHPDO) and to characterize their bladder function.
  
  
  METHODS
  A retrospective chart review of women diagnosed with IHPDO (detrusor pressures > 40 cm H2O during involuntary bladder contractions) from 2007 to 2010 was conducted. Women were assessed for VUR by X-ray voiding cysto-urethrogram. Renal ultrasound or CT urogram, serum BUN/creatinine, and urinalyses were performed if reflux reached the renal pelvices. Cystometric and voiding pressure study data were reviewed for detrusor overactivity pressure and volume, voiding dysfunction, urethral relaxation, compliance, and bladder outlet obstruction.
  
  
  RESULTS
  Sixty-five women were diagnosed with IHPDO, and 50 completed an X-ray voiding cysto-urethrogram. The median (range) detrusor overactivity pressure was 65 (41-251) cm H2O. Four (8.0%) women had IHPDO; none had upper urinary tract deterioration. The majority of women exhibited urethral relaxation with voiding, impaired compliance, and bladder outlet obstruction.
  
  
  CONCLUSIONS
  Women with IHPDO are at risk of low-grade vesico-ureteral reflux. However, most women with IHPDO are likely protected from reflux by intermittent exposure to high detrusor pressures and the ability to decompress the bladder by urethral relaxation.
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, NorthShore University HealthSystem, 9650 Gross Point Road, Suite 3900, Skokie, IL, 60076, USA, agafni-kane@northshore.org.
authors.forename: Adam
authors.initials: A
authors.lastname: Gafni-Kane
authors.forename: Peter K
authors.initials: PK
authors.lastname: Sand
mesh_terms: D000328:Adult; D000368:Aged; D003187:Compliance; D005260:Female; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D015995:Prevalence; D012189:Retrospective Studies; D014521:Urethra / Q000503:physiopathology; D001743:Urinary Bladder / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000150:complications* / Q000503:physiopathology; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology*