PS 23. Vesicoureteral reflux and bladder dysfunction

To emphasize the significance of bladder dysfunction in the management of vesicoureteral reflux (VUR), we reviewed current literatures and added the data of Severance Children's Hospital.

Since the first report in 1976, there have been a few studies revealing bladder dysfunction as the cause of VUR. It seems to elevate bladder pressure and distort bladder and UVJ architecture causing VUR. Bladder dysfunction also causes urinary tract infection (UTI). Milk back theory and residual urine from functional outlet obstruction could be the risk of UTI. Also, involuntary detrusor contraction can decrease the perfusion of bladder mucosa and thus, decrease the mucosal immunity increasing the risk of UTI. Based on the relationship between bladder dysfunction and VUR or UTI, the indirect and direct relationship between bladder dysfunction and renal scar has been also suggested. On the other hand, there have been reports suggesting VUR as the cause of bladder dysfunction. Possible theories are the volume overloading by VUR and abnormal development of ureteric bud. However, in our institution, we experienced only a few patients with bladder dysfunction were recovered from bladder dysfunction after anti-reflux surgery.

In conclusion, bladder dysfunction is closely related with the development and resolution of VUR. Aggressive antireflux intervention should be performed when the complete prevention of UTI fails especially in patients with bladder dysfunction. Also, bladder dysfunction should be surveiled even after disappearance of VUR either naturally or surgically.