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Vesicoureteral reflux—the role of bladder and bowel dysfunction

Nature Reviews Urology volume 10, pages 640–648 (2013)Cite this article

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Abstract

Vesicoureteral reflux (VUR) is a significant risk factor for clinical pyelonephritis and renal scarring. In 2010, the American Urological Association (AUA) reported that bladder and bowel dysfunction (BBD), which is common in patients with VUR, increases the risk of breakthrough UTI in children receiving antibiotic prophylaxis, reduces the success rate for endoscopic injection therapy, and increases the risk of postoperative UTI, irrespective of the surgical success rate for VUR. Accordingly, physicians are strongly recommended to investigate BBD in their patients with VUR. Symptoms and signs of BBD include urinary frequency and urgency, prolonged voiding intervals, daytime wetting, perineal and penile pain, holding manoeuvres (posturing to prevent wetting), constipation, and encopresis. Primary assessment tools include the Pediatric Symptom Checklist, urinalysis, urine culture, bladder diary, measurement of the postvoid residual urine volume, Dysfunctional Voiding Symptom Score, uroflow with electromyography, and Bristol Stool Form Score. The Rome III criteria can also be used for diagnostic assessment of bowel function. Treatment of BBD should be individualized, directed at symptomatic and objective improvement, and can include behavioural modification, biofeedback, selective use of anticholinergics and α-blockers, and bowel management.

Key Points

  • Vesicoureteral reflux (VUR) is a significant risk factor for clinical pyelonephritis and renal scarring

  • Children with VUR should undergo assessment for bladder and bowel dysfunction (BBD), which can place patients at increased risk of UTI

  • BBD reduces the likelihood of spontaneous resolution of VUR and the success rate of endoscopic injection therapy for VUR

  • BBD increases the risk of UTI in children undergoing surgical therapy for VUR, irrespective of surgical success

  • Assessment and treatment of BBD is imperative in the medical and surgical management of children with VUR

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Figure 1: Forest plots comparing reflux resolution rates among children.
Figure 2: Forest plots comparing rates of UTI in children.
Figure 3: The Bristol Stool Form Score chart, which can be used to evaluate bowel dysfunction in children with vesicoureteral reflux.
Figure 4: Typical urine voiding curves.
Figure 5

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Authors and Affiliations

  1. Department of Pediatric Urology, Vattikuti Urology Institute, Henry Ford Hospital, Children's Hospital of Michigan, 2799 West Grand Boulevard, K-9, Detroit, 48202, MI, USA

    Jack S. Elder & Mireya Diaz

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Both authors researched the data for the article and discussed its content, wrote the manuscript, and edited it before submission.

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Correspondence to Jack S. Elder.

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Elder, J., Diaz, M. Vesicoureteral reflux—the role of bladder and bowel dysfunction. Nat Rev Urol 10, 640–648 (2013). https://doi.org/10.1038/nrurol.2013.221

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