Urodynamic findings of pediatrics with history of failed anti-vesicoureteral surgery.

Abstract

Purpose: To evaluate the role of functional bladder dysfunction in failed vesicoureteral reflux (VUR) surgery through conventional urodynamic study.

Materials and methods: This cohort study was conducted at the Labbafinejad Hospital in 2020-2022. Patients <18 years with VUR who were referred with failed surgical intervention (persistence, progression, or recurrence of reflux on the same or opposite side) were included. Demographic information (sex, urinary tract symptoms, type of surgical intervention, and side and grade of VUR) and urodynamic study UDS results were recorded and analyzed statistically.

Results: 53 patients were referred with failed surgery, with an average age of 8.20 ± 3.88 and a male-to-female ratio of 0.76/1.25. Bilateral vesicoureteral reflux (VUR) was present in 47.2%. Detrusor overactivity (DO) and dysfunctional voiding (DV) were found in 41 (77.4%) and 37 (69.8%) patients. The mean maximum amplitude and frequency of DOs were 50.58 ± 43.12 and 9.02 ± 8.15. Patients with bilateral VUR had significantly higher DO (92% vs 64.2%, P = 0.022), DO amplitude (70.60 ± 40.78 vs 32.71 ± 37.43, P = 0.001), and DO frequency (11.52 ± 8.14 vs 6.79 ± 7.63, P = 0.034).

Conclusion: Individuals with failed VUR surgery commonly have UDS abnormalities and it is more severe in bilateral VUR patients. It can be postulated that non-surgical management and medications may be recommended as the first approach.