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Unlabelled: A small number of reports evaluating early effects of vesicoureteral reflux conservative therapy in children, based on antibacterial prophylaxis combined with correction of the of lower urinary tract function inspired us to perform the study. THE AIM OF THE STUDY was to assess the effects of vesicoureteral reflux (VUR) management in children according to grade, sex and way of treatment., Material and Methods: The study group consisted of 108 children, who were treated in 2000-2007 due to VUR. There were 162 refluxing ureters (grades I-V) diagnosed by voiding cystourethrography (VCU). In 82 children cystometry and (or) uroflowmetry were additionally performed, which revealed lower urinary tract disorders in 41 (60 refluxing ureters), mostly detrusor hyperactivity or detrusor-sphincter dyscoordination. All children had conservative treatment, A - in 67 (102 refluxing ureters) only antibacterial prophylaxis, B - in 41 of children (60 refluxing ureters) in combination with pharmacological treatment of urodynamic abnormalities., Results: The check-up VCU was performed after 23+/-15 months on average. VUR was observed to subside in 44/162 (28%) of refluxing ureters, including 22/108 (22%) of those treated managed with method A and 22/60 (37%) with method B. Fifty three of refluxing ureters were qualified for further conservative therapy and 65/162 (40%) for surgery (especially endoscopic). Following 2-3 years medical and surgical treatment, 87/162 (54%) refluxing ureters resolved., Conclusion: In the diagnostics of VUR in children we should take into consideration the assessment of lower urinary tract function, as treatment of these abnormalities increases the effects of VUR conservative management. However it should be confirmed on a larger group of patients.

Unlabelled: Lower urinary tract dysfunction plays significant role in patogenesis of vesicoureteral reflux (VUR). Thus, urodynamic assessment is very useful in diagnosis and treatment of VUR., Aim: Assessment of the incidence of urodynamic disturbances among children with VUR., Material and Methods: Retrospective assessment of 125 children with VUR including 93 assessed urodymically., Results: Urodynamic disturbances were found in 58 patients (70.9% of examined children), of which--detrussor hyperactivity in 25 (43.1% of children with urodynamic disturbances), detrussor hyperactivity with subvesical obstruction or dysfunctional voiding in 6 (10.3%), dysfunctional voiding in 17 (29.3%), anatomical subvesical obstruction in 9 (15.5%), detrussor hypotony in 1 (1.7%). No disturbances were found in 27 (29.1% of examined children). Children with detrussor overactivity were the prevalent group among all children with lower urinary tract dysfunction., Conclusions: Children with lower urinary tract dysfunction constitute a significant part of children with VUR.

Understanding the role of urodynamic conditions in the bladder with vesicoureteral reflux (VUR) have changed the cause-effect relationship between vesicoureteral reflux and urinary tract infections (UTI) in children. It is not a presence of UTI itself that decides on VUR appearance but accompanying voiding dysfunction. Dysfunctional voiding causes functional urinary tract obstruction which increases intravesical pressure during storage and voiding, and contributes post-voiding residuals. When intravesical pressure exceed ureteric opening pressure the VUR occurs and UTI develops because of urinary stasis. It was noticed that high voiding pressure contributed 90% of VUR in infants. If bladder dysfunction is a fundamental factor in VUR creation, the treatment of VUR should focus on elimination of this dysfunction. Endoscopic subureteric injection could be used as an additional treatment, particularly reducing recurrences of febrile UT.

Unlabelled: The aim of the study was to assess the rate of development of voiding dysfunction (VD) in patients with reflux nephropathy. We investigated 150 pts with vesicoureteral reflux (VUR): 33 boys and 117 girls in mean age 9 +/- 3.3 years with normal renal function. In all pts we performed renal scintigraphy (DMSA) and ABPM. Renal scarring by DMSA scan was categorized into grades 1-4. In all pts we assessed high and laterality of VUR, renal function (clearance creatinine--Ccr) and occurency of hypertension (HT)., Results: Of 150 pts, 80 (53.3%) developed VD (54.5% boys and 52% girls). DMSA grade: 1--27 pts, 2--85 pts; 3--31 pts; 4--7 pts. No statistically significant difference was found depends of: sex, age, laterality of renal damage in DMSA, unilateral and bilateral reflux for the development of VD. The incidence 3-4 grade in DMSA scan was significantly higher in pts with IV-V grade of VUR in comparison to pts with lower grade of VUR in group with and without voiding dysfunction. IV-V grades of VUR were observed more frequently in pts with bladder/sphincter dysfunction. The occurency of HT in group with VD and without VD was 12 pts (15%) and 8 (11.4%) respectively (ns). Pts with VD have lower Ccr in comparison with pts without VD (129.1 vs 136.3 ml/min/1.73 m2; p<0.05)., Conclusions: Approximately 50% of patients with VUR demonstrated VD. VD occurred independent of age. IV-V degrees VUR and more severe changes in DMSA scan were seen in pts with bladder/sphincter dysfunction.

Unlabelled: Low birth weight (bw) has been related to low nephron number and hypertension. Age is an important predictor of developing hypertension in patients with reflux nephropathy (RN). The aim of the study was to assess the relationships between birth weight and blood pressure in children with RN. We investigated 150 patients in mean age 9 +/- 3.3 years with vesicoureteral reflux. In all patients we collected birth weight, we also performed renal scintigraphy (DMSA) and 24-hour ambulatory blood pressure monitoring (ABPM). Standard deviation score body mass index (BMI SDS) was calculated. In ABPM mean value of systolic and diastolic blood pressure (sBP, dBP), blood pressure load during 24 hour and during day and nighttime (LsBP, LdBP) were analyzed. As objective parameters of BP in children in different age and hight, systolic and diastolic BP indices (sBPI, dBPI) were calculated., Results: In analyzed group of children mean bw was 3340 +/- 587 g (from 1300 to 5000 g); in 10 children bw was <2500 g. In 20 children (13%), in 3 with bw <2500 g (30%) and in 17 (12.5%) with normal bw hypertension was diagnosed. The mean age and BMI SDS were lower in children with bw < 2500 g and HT than in children with normal bw and HT (8.2 vs 9.9 years and median -0.53 vs -0.22 respectively). In children with HT mean bw was 3247 +/- 666 g and in children without HT 3293 +/- 461 g (NS). No statistically significant difference was found depends of grades of renal damage in DMSA scan for bw. The negative correlation was found between bw and sBPI, LsBP during 24h and sBPI i LsBP during nighttime (p<0.05 r=-20, p<0.05 r=-19; p<0.05 r=-16, p<0.01 r=-26 respectively). No correlation was found between bw and dBP values., Conclusion: In children with RN low bw may be a potential risk factor for developing hypertension independent of severity of renal scarring.

The analysis presents 622 children in the age ranged from 4 months to 14 years, operated on vesicoureteral reflux. The treatment was carried on in Department of Pediatric Surgery in Poznan between 1983 and 1992. All these children were operated on with antireflux Politano-Leadbetter technique, modified by Sarrazin, protecting reimplanted ureters with stenting catheters. Duplicated ureters were reimplanted "en bloc" according to Bettex technique, also with Sarrazin modification. Preoperative parameters included: history, radiological evaluations: voiding cystourethrogram, intravenous pyelogram or ultrasound imaging, endoscopic evaluations--cystourethroscopy (with meatal calibration in girls), laboratory blood and urine results. The reflux degree was estimated according to international classification IRSC. There were 12 (2%) children with II degree, 498 (80%) with III degree, 101 (16%) with IV degree and 11 (2%) patients with V degree reflux. In order to compare the results of operative treatment, all analyzed children were subdivided into groups: 303 (48.7%) patients with primary reflux, 77 (12%) with reflux to duplicated pyelo-ureteral systems, 17 (2.7%) with refluxing megaureters, 66 (10%) with reflux to hypoplastic kidney, 99 (15.9%) with cystic cystitis and 114 (18%) children with urethral meatal stricture. Good recovery with uncomplicated postoperative course was obtained in 606 (97.4%) patients. Early postoperative complications occurred in 16 (2.6%). In outpatient control the results of urinalysis and urine cultures, ultrasound imaging and voiding cystourethrograms were tested. Urine cultures were negative in 501 (80.5%) patients 3-4 weeks after discharge increasing to above 92% of patients 6 months after operation. In postoperative imaging control, 600 (96.5%) patients presented with normal status of upper urinary tract, in 14 (2.2%) transient dilatation of reimplanted ureters was observed and in 8 (1.3%) ureters had to be reimplanted because of secondary dilatation. After 6 months postoperative voiding cystourethrograms showed cessation of reflux in 589 (94.6%) patients, in 33 (5.2%) recurrent reflux was observed, which disappeared in 20 of them in control. In 13 patients urodynamic evaluation showed vesicourethral dysfunction, medically curable.