The impact of treated dysfunctional voiding on the nonsurgical management of vesicoureteral reflux.

Abstract

We evaluated the impact of dysfunctional voiding on the nonsurgical management of vesicoureteral reflux in toilet trained children. The study population comprised 107 girls and 21 boys 3 to 10 years old who were diagnosed with vesicoureteral reflux during evaluation for urinary tract infection or dysfunctional voiding. Dysfunctional voiding was identified prospectively on the basis of typical symptoms. All patients with a urinary tract infection received antibiotic prophylaxis and oxybutynin was prescribed for all those with dysfunctional voiding. Girls with dysfunctional voiding who had no history of urinary tract infection were also given daily antibiotic prophylaxis. Of the 128 patients 51 girls and 15 boys had dysfunctional voiding. Reflux spontaneously resolved in 27 of the 44 evaluable girls (61%) with normal and 19 of the 42 (45%) with dysfunctional voiding. A breakthrough urinary infection developed in 18 girls (43%) with versus only 5 (11%) without dysfunctional voiding (p = 0.001). No boys had a breakthrough infection. Despite anticholinergic therapy and antibiotic suppression 43% of the girls with dysfunctional voiding in whom reflux may otherwise have resolved spontaneously had a breakthrough urinary infection leading to surgery.