Can Bladder Function Characteristics Be Recognized in a Vcug in Young Children with Vesicoureteral Reflux

Abstract

PURPOSE The aim of the study was to investigate if bladder function variables could be recognized as radiological signs in the VCUG in children with vesicoureteral reflux (VUR). MATERIAL AND METHODS 116 patients with high-grade VUR had videocystometry at median age 6, 21 and 39 months. X-ray films of the bladder was reviewed for size (big = above the line between the iliac crests, small = below the line between the lower ends of sacroiliac junctions), pathology of the bladder wall (irregular, trabeculated, diverticula) and pathology of the bladder neck / proximal urethra (urethral sphincter closed with filling of the posterior urethra - PUF). RESULTS Bladder volume estimated from the X-ray films (big, normal, small), correlated well to bladder volumes obtained from the urodynamic investigations, with significant difference between the groups (p<0.001). Regression formulas have been constructed for the respective bladder size on X-ray in ml versus age. Small bladders were characteristic for the infant group and big bladders for children after age 1 year. Low age (<1 year) was significantly correlated to pathology of the bladder wall and the presence of PUF both during the filling and voiding phase. Abnormalities of the bladder wall also correlated to low bladder capacity and overactive contractions during filling. PUF during filling significantly correlated to high pressure overactive contractions and PUF during voiding to high voiding pressure. CONCLUSIONS Our observations indicate that bladder capacity could roughly be estimated from x-ray films by using the landmarks suggested in this study. The typical urodynamic pattern for small infants: low bladder capacity, overactivity, high voiding pressure and dyscoordination at voiding was recognised in X-ray films from VCUG.