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THE SWEDISH INFANT HIGH GRADE REFLUX TRIAL - BLADDER FUNCTION
Sofia SJÖSTRÖM
1
, Josefin NORDENSTRÖM
1
, Rune SIXT
1
, Eira STOKLAND
2
and Ulla SILLÉN
3
1) The Queen Silvia Children's Hospital, The Uro-Nephrologic Center, Gothenburg, SWEDEN - 2) The Queen Silvia
Children's Hospital, The Pediatric Uro-Nephrologic Center, Gothenburg, SWEDEN - 3) The Queen Silvia Children's
Hospital, The Uro-Nephrologic Center, Gothenburg, SWEDEN
PURPOSE
Infants with high-grade vesicoureteral reflux (VUR) often have lower urinary tract dysfunction (LUTD), characterized by
high capacity bladder (BC) and incomplete emptying. The aim of this study was to evaluate whether early VUR
resolution could prevent the bladder from becoming large i.e. to prevent LUTD.
MATERIAL AND METHODS
The study included 77 infants (55 boys)<8 months, VUR grade 4-5 (n=30/n=47) and randomized to CAP(39)/
endoscopic treatment (ET)(38). Voiding cystourethrogram/videocystometry and free voiding observation were
performed at study entry and 1-year follow-up. LUTD was defined as large BC (>150% of expected for age) and mean
residual urine >20ml. Bladder function outcome was related to VUR resolution (≤grade2 versus >grade2) for both
treatment groups together.
RESULTS
At baseline LUTD was seen in 25% (18/72), high BC 42% and high residual 36%. At follow-up the number with high BC
in free voiding studies had decreased (34%),with no difference between treatment groups. A relation with VUR
resolution was seen with lower BC in VUR-group≤2 (p=0,050). In addition, number of children with LUTD at baseline
was lower (12%) in those with resolution compared to those with non-resolution, and was highest (45%) in the non-
resolved bilateral grade 5 (p=0.029).
CONCLUSIONS
The decrease in BC in children with non-dilating VUR at follow-up might indicate a role of refluxing volume in the
development of high BC. However, since LUTD at baseline seems to be a negative predictor for resolution, both after ET
and spontaneous, it seems as the severity of the congenital anomaly decide what happens to the bladder and the VUR.