THE IMPACT OF TREATED DYSFUNCTIONAL VOIDING ON THE NONSURGICAL MANAGEMENT OF VESICOURETERAL REFLUX

Purpose: We evaluated the impact of dysfunctional voiding on the nonsu rgical management of vesicoureteral reflux in toilet trained children. Materials and Methods: The study population comprised 107 girls and 2 1 boys 3 to 10 years old who were diagnosed with vesicoureteral reflux during evaluation for urinary tract infection or dysfunctional voidin g. 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 wi th dysfunctional voiding. Girls with dysfunctional voiding who had no history of urinary tract infection were also given daily antibiotic pr ophylaxis. Results: Of the 128 patients 51 girls and 15 boys had dysfu nctional voiding. Reflux spontaneously resolved in 27 of the 44 evalua ble 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. Conclusions: Despite anticholinerg ic therapy and antibiotic suppression 43% of the girls with dysfunctio nal voiding in whom reflux may otherwise have resolved spontaneously h ad a breakthrough urinary infection leading to surgery.