Abstract

Objectives: In this study, we examined the frequency and relationship of vesicoureteral reflux (VUR), urinary tract infection (UTI), and renal parenchymal damage in a group of children with bladder dysfunction, presenting daytime incontinence.

Material and Methods: The medical records of 133 pediatric cases with daytime wetting between 1992 and 2002 were analyzed retrospectively. Bladder dysfunction was described as filling phase dysfunction and voiding phase dysfunction. The rates of VUR, symptomatic UTI, febrile UTI, renal scars, constipation, and results of conservative and surgical therapy were compared between two groups. Chi square test was used for statistical analysis.

Results: There were 108 children in filling phase group and 25 children in voiding phase group. Median age was 8 years (range 4-14 years) in filling phase, and 10 years (range 4-17 years) in voiding phase group.

Complete and partial continence was achieved in 52% and 34% of the cases in filling phase group respectively. In voiding phase group complete and partial response rates were 26% and 57%.

VUR was detected in 42% of the patients in filling phase group. Spontaneous resolution rate of VUR was 50%. Success rates of endoscopic injection treatment and open surgery for reflux were 40% and 100% respectively.

In voiding phase dysfunction group VUR incidence was 75%. Early surgical intervention was required in 81% of the cases. Success rates of endoscopic injection and open surgery were 71% and 85% respectively in this group.

Symptomatic UTI was detected in 68% (54% were febrile UTI) of the cases in filling phase group. When VUR existed, rate of febrile UTI increased to 75%. In voiding phase group symptomatic and febrile UTI rates were 94% and 83% respectively. When VUR accompanied VUR, febrile urinary tract infection rate was 83%.

Renal parenchymal scaring was significantly high in patients with VUR in filling phase dysfunction group in voiding phase dysfunction group all patients with VUR had renal scars.

The incidence of constipation was 52% in filling phase group and 76% in voiding phase group.

Conclusion: Vesicoureteral reflux, symptomatic urinary tract infection, febrile urinary tract infection and constipation rates were high in patients with bladder dysfunction. Bilateral high-grade reflux, UTI and constipation were more prominent in voiding phase dysfunction. VUR seems to play an important role in the development of renal parenchymal damage in patients with bladder dysfunction. Open anti-reflux procedures performed in patients with filling phase dysfunction were successful as in primary reflux. Since, success of open procedures in patients with voiding phase dysfunction was lower than in filling phase dysfunction patients.