THE RELATIONSHIP AMONG DYSFUNCTIONAL ELIMINATION SYNDROMES, PRIMARY VESICOURETERAL REFLUX AND URINARY-TRACT INFECTIONS IN CHILDREN

Purpose: We determine whether functional bladder and/or bowel disorder s influence the natural history or treatment of children with primary vesicoureteral reflux. Materials and Methods: We assessed 143 children with primary vesicoureteral reflux that stopped spontaneously or was surgically corrected for functional bowel and/or bladder disorders, in cluding bladder instability, constipation and infrequent voiding, term ed the dysfunctional elimination syndromes. Results: Dysfunctional eli mination syndromes were present in 66 of 143 children (43%) thought to have primary vesicoureteral reflux, Of these 66 patients 54 (82%) had a breakthrough urinary tract infection and underwent reimplantation c ompared to only 18% without the syndromes. Of 70 children who had a br eakthrough urinary tract infection dysfunctional elimination syndromes were present in 54 (77%) and absent in 16 (23%). Of the remaining 73 patients who did not have a breakthrough infection dysfunctional elimi nation syndromes were present in 12 (16%) and absent in 61 (84%). In c hildren with dysfunctional elimination syndromes the resolution of ref lux that was 1 grade less severe required an average of 1.6 years long er. After the disappearance of reflux, urinary tract infection develop ed in 18 children, including 14 (78%) with dysfunctional elimination s yndromes. Unsuccessful surgical outcomes involving persistent, recurre nt and contralateral reflux occurred only in children with dysfunction al elimination syndromes. Conclusions: Dysfunctional elimination syndr omes are common and are often unrecognized in children with primary re flux, These syndromes are associated with delayed reflux resolution an d an increased rate of breakthrough urinary tract infection, which lea ds to reimplantation surgery. Dysfunctional elimination syndromes also adversely affect the results of reimplantation and represent a risk f or recurrent urinary tract infection after reflux resolves. The evalua tion and management of dysfunctional elimination syndromes should be a n integral part of the treatment of every child with vesicoureteral re flux. Effective evaluation and treatment may be made cost-effective by decreasing the followup, the number of breakthrough urinary tract inf ections and the number of children requiring reimplantation.