Bladder dysfunction in children with vesico-ureteric reflux

Vesico-ureteric reflux and non-neurogenic bladder dysfunction are closely r elated, although a causal relationship has been established only for severe forms of detrusor-sphincter dyscoordination. There are several urodynamic studies reporting high frequency of bladder instability and/or detrusor-sph incter dyscoordination in children with reflux. The latter includes an elem ent of functional outflow obstruction and is the most serious, since it acc ompanies kidney damage. When instability is the only urodynamic abnormality damage is absent. There are indications that treatment of bladder dysfunct ion increases spontaneous resolution of reflux and, furthermore, that bladd er dysfunction is a negative prognostic factor following antireflux surgery . Recently also, gross reflux in infant boys was seen to associate with bla dder dysfunction in addition to earlier finding of congenital malformation of the ureterovesical junction. However, no comparisons have emerged on the outcome following treatment of bladder dysfunction and following observati on only. In conclusion, children with reflux on chemoprophylaxis prior to r eimplantation must always be assessed for bladder dysfunction. This is espe cially important when there are recurrent urinary tract infections.