Enkele aspecten van de kinderurologie

Rede, uitgesproken bij de aanvaarding van het ambt van gewoon hoogleraar in de kinderurologie aan de Faculteit der Geneeskunde van de Erasmus Universiteit Rotterdam op woensdag 19 september 197

The role of videourodynamic studies in diagnosis and treatment of vesicoureteral reflux

Abstract From January 1986 to January 1988, 63 children with 95 refluxing ureters have been studied in a prospective study with videourodynamic examination. All children with reflux grades I, II, and III received antibacterial treatment. Surgical treatment was adopted for reflux grades IV and V, provided detrusor instability had been excluded. However, if there was detrusor instability, anticholinergic drugs and antibacterial treatment were given in all grades of reflux and videourodynamic examination was repeated after 3 to 6 months and after 12 months of therapy. Bilateral reflux was found in 22 of 38 patients with a stable bladder, and reimplantation was performed in 11 patients with 18 refluxing ureters. In 25 children with 35 refluxing ureters of various grades of reflux, detrusor instability was found and unilateral reflux was noted more frequently than bilateral reflux. Surgery was necessary for only five children, because in the majority of the patients detrusor instability and reflux could be treated by anticholinergic drugs and antibacterial treatment. For the decision as to which treatment should be given in vesicoureteral reflux, a videourodynamic study is mandatory

Vesicoureteric reflux and videourodynamic studies: Results of a prospective study after three years of follow-up

Objective. To study prospectively the influence of videourodynamic studies on the management of children with vesicoureteric reflux. Methods. One hundred one children with reflux were investigated routinely with videourodynamic studies, as well as renal scans, ultrasound studies, and/or intravenous urograms. The studies were repeated at one, three, and five years. If bladder instability was demonstrated, the primary treatment consisted of anticholinergic drugs and antibiotics, regardless of the grade of reflux. In reflux Grades IV and V with instability and renal scars, surgery was performed. In case of a stable bladder, reflux Grades I–III received antibacterial treatment, while surgical correction was used for reflux Grades IV and V. Results. The results of three years of follow-up of 101 children are reported. Bladder instability was found in 39 children. Thirty of them with reflux Grades I–-IV and instability could be managed with anticholinergic and antibacterial drugs, while 9 needed surgical correction. Conclusions. A voiding cystourethrogram is only sufficient for the detection of reflux but for correct management of these children a (video) urodynamic study is mandatory. After treatment of frequently found bladder dysfunction, the reflux will disappear in the majority of cases