Dysfunctional Elimination Syndrome Is a Negative Predictor for VUR

Abstract

Urology| June 01 2007 Dysfunctional Elimination Syndrome Is a Negative Predictor for VUR AAP Grand Rounds (2007) 17 (6): 69–70. https://doi.org/10.1542/gr.17-6-69 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Dysfunctional Elimination Syndrome Is a Negative Predictor for VUR. AAP Grand Rounds June 2007; 17 (6): 69–70. https://doi.org/10.1542/gr.17-6-69 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: dysfunctional elimination syndrome, urinary tract infections Source: Colen J, Docimo SG, Stanitski K, et al. Dysfunctional elimination syndrome is a negative predictor for vesicoureteral reflux. J Pediatr Urol. 2006;2:312–315; doi:10.1016/j.jpurol.2006.01.013 Researchers from the Children’s Hospital of Pittsburgh conducted a retrospective review to examine the rates of vesicoureteral reflux (VUR) in patients being evaluated for urinary tract infection (UTI) that was accompanied by fever (>38.0°C) and/or dysfunctional elimination syndrome (DES). DES was defined as the presence of one or more of the following: posturing, daytime wetting, urgency, constipation, encopresis, or a previous diagnosis of DES. The medical records of all patients who underwent voiding cystourethrograms (VCUG) for the diagnosis of UTI from 1997–2000 were evaluated. Patients without a documented infection and those with other reasons for UTI or VUR including urolithiasis, neurogenic bladder, urethral valves, ureteroceles, or complex anomalies were excluded. Children less than two years of age were assessed separately due to the difficulty of diagnosing DES in this population. One hundred thirty-two patients (122 girls; 112 white, 8 black, 18 unknown) met the criteria. VUR was identified in 48% (64/132): 54% (7/13) of patients who were afebrile and DES negative; 35% (12/34) of those who were afebrile and DES positive; 68% (23/34) of the febrile without DES group; and 43% (22/51) of those who were febrile and DES positive. Patients who were afebrile and diagnosed with DES were less likely to have VUR than patients who were febrile without DES (P=.02); among the febrile patients, those with DES were less likely than those without DES to have VUR (P=.01). Dilating VUR (grades III–V) was most common in febrile patients without DES (11/34). The authors note that the detection rate for VUR is higher in this study than in a previous series1 and attribute this to selection bias. One-third of VCUGs in this review were ordered by the urology department with the remainder ordered by primary care physicians. Some of the patients had VCUGs performed at other hospitals and it was presumed that most patients with VUR were referred to the urology department for management while those with normal studies were not, increasing the VUR population. The authors conclude that DES appears to be a negative predictor for VUR. Dr. McMahon has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/ investigative use of a commercial product/device. The association of dysfunctional voiding and constipation with urinary tract infection was noted in the last decade. The term DES was introduced in 19982 and at that time it was suggested that reflux is often secondary to the abnormal bladder dynamics found in patients with DES. A dysfunctional voiding symptom score3 was developed and studies demonstrated that improvement in the score was associated with resolution of VUR while worsening of the score was associated with breakthrough UTI and even increasing reflux.4 The authors of the current... You do not currently have access to this content.