20 cm H2O) (n= 93). FLUOROSCOPY - morphology of the ureter: oNarrow ureter (n= 135), Megaureter (n= 216), ,,Special types" of ureters: Refluxing/stenotic megaureter (n= 34), Narrow ureter, pelvic distension (n= 18), Transient reflux (n= 57). Interpretation of VIDEO-CYSTOMETRY vs. CYSTOMETRY results: More reliable in estimating: bladder capacity, intravesical pressure, compliance. Safe method (no fear of uncontrolled renal reflux). VIDEO-CYSTOMETRY vs. CYSTOGRAPHY: more sensible in detecting VUR, more adequate in estimating the grade of VUR, and information about the function/dysfunction. Conclusions. Vesico-ureteric reflux is more complicated condition to be described only in traditionally used Parkkulainen scale. Video-cystometry has an important impact on decision-making in children with reflux pathology: in low pressure reflux - endoscopy / surgery, in cases of high pressure reflux - conservative treatment of voiding dysfunction.">
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CODE: 10.1 - Functional assessment of vesico-ureteral reflux based on video-urodynamic studies
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Paweł Kroll 1, Andrzej Jankowski 1, Przemysław Mańkowski 1, Jacek Zachwieja 2, Alfred Warzywoda 2
1 Katedra Chirurgii Dziecięcej, Klinika Chirurgii, Urologii i Traumatologii Dziecięcej AM w Poznaniu
2 Katedra i Klinika Nefrologii Dziecięcej AM w Poznaniu

summary

Introduction. Vesico-ureteric reflux is one of the most common problems in pediatric urology. Video-cystometry allows for simultaneous estimation both of the function and morphology of the bladder and ureters in children with vesico-ureteric reflux.
Objectives. Evaluation of morphology of refluxing ureters based on video-urodynamic studies.
Materials and methods. During last 6 years (1998-2004) 510 video-urodynamic studies were performed: in children with detected VUR (n=253): number of all refluxing ureters (n= 351), unilateral (n= 155) and bilateral (n= 98), age: 1 month - 19 y., with neurogenic bladder (n=164), non-neurogenic bladder (n= 81), post-augmentation bladder (n=8). Qualification for video-UD: signs of voiding dysfunction and: abnormality revealed by upper urinary tract ultrasonography, or/and previously diagnosed vesico-ureteric reflux, or/and recurrent urinary tract infections. Method, equipment: sets for urodynamics and fluoroscopy.
Technique. Instillation of the contrast medium by double lumen catheter.
Results. Non-neurogenic patients (n= 81); VUR during storage (passive); no urodynamic pathology and low pressure VUR (n= 39); urodynamic pathology and high-pressure VUR (is it passive?) (n= 42); VUR during voiding (active) (Pdetr>20 cm H2O) (n= 52). Neurogenic patients (n= 164): low ,,Leak point" pressure (Pdetr< 40 cm H2O) (n=41), high leak point pressure (n=123), low-pressure reflux (Pdetr<20 cm H2O) (n= 71), high-pressure reflux (Pdetr>20 cm H2O) (n= 93). FLUOROSCOPY - morphology of the ureter: oNarrow ureter (n= 135), Megaureter (n= 216), ,,Special types" of ureters: Refluxing/stenotic megaureter (n= 34), Narrow ureter, pelvic distension (n= 18), Transient reflux (n= 57). Interpretation of VIDEO-CYSTOMETRY vs. CYSTOMETRY results: More reliable in estimating: bladder capacity, intravesical pressure, compliance. Safe method (no fear of uncontrolled renal reflux). VIDEO-CYSTOMETRY vs. CYSTOGRAPHY: more sensible in detecting VUR, more adequate in estimating the grade of VUR, and information about the function/dysfunction.
Conclusions. Vesico-ureteric reflux is more complicated condition to be described only in traditionally used Parkkulainen scale. Video-cystometry has an important impact on decision-making in children with reflux pathology: in low pressure reflux - endoscopy / surgery, in cases of high pressure reflux - conservative treatment of voiding dysfunction.