Abstract

VIRSEDA CHAMORRO, Miguel et al. Urodynamic factors associated to vesicoureteral reflux in adults. Arch. Esp. Urol. [online]. 2006, vol.59, n.7, pp.707-712. ISSN 0004-0614.

Objetives: Lower urinary tract dysfunction may affect the upper urinary tract with development of vesicoureteral reflux. The objective of our study is to evaluate what lower urinary tract dysfunctions areassociated with vesicoureteral reflux in adults. Methods: We performed a cross-sectional study in a sample of 236 patients (149 males and 87 females) with a mean age of 45.5 yr. (typical deviation 19.0 yr.) submitted for videourodynamic study for lower urinary tract functional symptoms. History and neurourologic physical examination, filling cystometry associated with videocystography, pressure/flow study associated with voiding videocystography and selective electromyography of the periurethral sphincter were done in all patients. The chi-square test was used for statistical analysis. Results: The presence of vesicoureteral reflux was observed in 19 patients (8.1% of the sample). Fifteen cases (79%) showed reflux during the filling phase, 3 cases (16%) during the voiding phase, and in 1 (5%) in both. The existence of a vesicourethral neurogenic dysfunction was confirmed in 8 cases (42%); there was no neurogenic dysfunction in 11 cases (58%). The vesicoureteral reflux was classified as primary passive (without any urodynamic anomaly) in one case (5%), passive with diminished compliance in 4 cases (21%), passive evolutive in 3 cases (16%), active involuntary in 7 cases (38%), active associated with organic obstruction of the lower urinary tract in one case (5%), activeassociated with increased contractile potency in one case (5%), and secondary to abdominal press in 2 cases (10%). The only urodynamic anomalies associated with a significant increase of the prevalence of vesicoureteral reflux were: a filling pressure at maximum capacity greater than 12.5 H₂O cm (prevalence of reflux 7 times) and voiding with abdominal press which increased theprevalence of reflux 2.8 times. Conclusions: Most patients with functional symptoms of the lower urinary tract and associated vesicoureteral reflux present lower urinary tract dysfunctions that may justify their reflux. Nevertheless, a statistically significant increase of the prevalence of vesicoureteral reflux was only found in patients with filling pressures at maximum capacity greater than 12.5 cm H₂O and those voiding with the help of abdominal press.

Keywords : Vesicoureteral reflux; Urodynamics; Risk factors.

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