The Natural history of transient urodynamic abnormality of infancy with high grade Primary Vesicioureteral Reflux: Follow up to early childhood

Abstract

PURPOSE The natural history of the bladder in children with severe primary VUR has not been known well. The aim of this study is longitudinal follow up of evolution of bladder function in this cohort. MATERIAL AND METHODS Infants with primary VUR (grade >III) were recruited. At entry, each patient underwent a voiding cystourethrogram, isotopic renogram and both natural filling and conventional filling urodynamic (UD) studies. UD patterns were classified as normal, overactive, dyssenergic/dysfunctional, obstructive and hypocontractile. On follow up, bladder function was primarily assessed using uroflowmetry and ultrasonosonography and UD assessment was repeated if required. Correlation between UD findings and outcome of VUR and bladder function at a mean follow up period of 4.7yrs was evaluated. RESULTS Thirty-five patients (M/F:28/7, meanage:8.65 m) were followed. Bladder function was abnormal in 23(9 Overactive, 4 Obstructive, 5 Dyssenergic/Dysfunctional, 5 underactive) and normal in 12 initially. Among the children with normal bladder function VUR resolved in 11 patients (91.6%) at 24 months and none had VUR. None of the patients with bladder dysfunction achieved VUR resolution.Bladder dysfunction resolved in 3 with an early overactive bladder. All children with obstructive pattern initially were treated surgically and achieved complete resolution of VUR and bladder dysfunction at 4.6yrs. Children with dyssenergic and underactive features initially, VUR persisted in all at 24 months. Persistence of bladder dysfunction was observed in all. CONCLUSIONS Our RESULTS demonstrated that transient UD dysfunction of infancy has persisted into early childhood in a significant proportion of children. An initial urodynamic categorization of the voiding dysfunction and abnormal bladder function revealed that those with dysynergic and hypocontractile bladders have shown barely any improvement in bladder function on follow up. However, excellent outcome has been seen in those with initial obstructive pattern after appropriate surgical intervention.