Comparison of the Voiding Pattern in Toilet-trained Filipino Children with Urinary Tract Infection With and Without Vesicoureteral Reflux: A Prospective Study

Abstract

Objectives: Vesicoureteral reflux (VUR) is a common abnormality of the urinary tract in children and remains a dilemma that is commonly seen by physicians. Unrecognized VUR associated with UTI may lead to long term effects on renal function and overall patient health. To date, there is no current study on voiding patterns of children presenting as recurrent UTI with and without VUR. In this study, the authors aim to determine if there is a difference in the voiding pattern of toilet trained Filipino children with UTI between those with and without VUR and to see if there is association between these parameters with the degree of VUR.

Materials and Methods: The study employed a prospective research design. Population consisted of pediatric patients seen in the clinic diagnosed as a case of UTI documented with positive urine culture. Voiding cystourethrogram was done to determine presence or absence of VUR. The procedure was done by a single Urologist at a single institution. The patients were then subdivided into 2 groups, the first group consisted of patients with UTI with VUR and another group had those with UTI but without VUR. A subanalysis was done to determine association depending on the degree of reflux. Logistic regression analysis, chi-square test and ANOVA were used to determine if there was any statistically significant difference between the two groups.

Results: A total of 223 pediatric patients with ages ranging from 2 years to 17 years with mean age of 9.5 years with documented urinary tract infection were noted. Among these, only 140 patients underwent VCUG hence included in the study. It consists of 57 male patients (40%) and 83 female patients (59%). Among these patients, 65 patients (46%) had vesicoureteral reflux and 75 patients (53%) had no vesicoureteral reflux. Each patient's voiding parameters such as bladder wall thickness, bladder capacity, postvoid residual, Qmax and voiding pattern were noted and compared between groups. A subanalysis was also done to determine any association of these parameters to the degree of reflux.

Conclusion: In the present series, bladder capacity was the only parameter found to be statistically different between those with and those without VUR. Furthermore, this difference was only seen among those with grades 3, 4 and 5 refluxes. Future study must be carried out to determine its clinical significance. Physicians must be vigilant and must have a high index of suspicion in dealing with patients with episodes of febrile UTI. To date, voiding cystourethrogram is still the gold standard to diagnose this disease entity.