IS RESOLUTION OF VESICOURETERAL REFLUX BY CONSERVATIVE MANAGEMENT PREDICTABLE IN PATIENTS WITH MYELODYSPLASIA

Objective: To evaluate the probable factors that might predict the out come of conservative management of vesicoureteric reflux (VUR) in myel odysplastic patients, Patients and Methods: A retrospective review of 24 children with VUR secondary to neurogenic bladder (l5 girls and 9 b oys, age range 1-18 years) out of 75 myelodysplasia patients between 1 994 and 1996 was made, Patients were grouped according to their respon se to conservative management: Group I: patients with their VUR resolv ed or downgraded (n = 15), and group II: patients with their VUR uncha nged or increased (n = 9), The following parameters were compared betw een the two groups: age, sex, VUR grade and laterality, urodynamic par ameters (bladder capacity, compliance, leak point pressure), type of b ladder neuropathy, accompanying neuropathology (walking problem, anal incontinence), Results: Most of the parameters studied failed to predi ct the outcome of conservative management of VUR in patients with neur ogenic bladder dysfunction, Higher grades of VUR if bilateral seem to benefit more from conservative management than lower grades do, Conser vative management appears to be more effective in hyperreflexic bladde rs than areflexic bladders in terms of VUR resolution, Conclusion: Alt hough prediction of patients resistant to conservative management of V UR could save myelodysplastic children from prolonged risk of renal da mage, current methods of evaluation are of very little help in this as pect.