Lower urinary tract symptoms in adults treated for vesico-ureteral reflux in childhood, compared to healthy controls
DOI:
https://doi.org/10.2340/sju.v61.45318Keywords:
Vesicoureteral reflux, LUT symptoms, NASHA-dx copolymer, long-term follow up study, enuresis, incontinence, pyelonephritisAbstract
Objective: To compare lower urinary tract (LUT) symptoms in young adults with previous vesico-ureteral reflux (VUR) and healthy controls. VUR is associated with LUT dysfunction in childhood but less is known regarding long-term prognosis.
Methods: A questionnaire was sent to 483 patients treated for VUR between 1993 and 2003 and a control group of 640 healthy young adults. Presence of LUT symptoms was compared by multivariable logistic regression, expressed as odds ratios (OR) and 95% confidence intervals (CI), adjusting for age, sex and body mass index.
Results: The study group response rate was 45.8% versus 41.9% in the controls. There was a female predominance in both groups (77.9% and 74.3%). Overall, 45.7% of the VUR group and 36.6% of the controls reported current LUT symptoms, with unspecified LUT symptoms being significantly more common (OR = 3.86, 95% CI 1.33–11.20), especially in individuals receiving single treatment, and women without a pregnancy history. A larger proportion of those with VUR reported childhood incontinence than controls (20.4% vs. 5.6%, OR = 3.86, 95% CI 1.53–9.79). There were no significant differences in pyelonephritis during adulthood, yet individuals in the VUR group tended to have a higher micturition frequency than controls.
Conclusion: Bladder dysfunction related to VUR during early childhood seems to improve with age, yet voiding difficulties and a higher micturition frequency appeared to remain more common in adults, predominantly females, with previous reflux than in healthy controls.
Downloads
References
Stokland E, Hellström M, Jacobsson B, et al. Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scin-tigraphy. J Pediatr. 1996;129(6):815–820. https://doi.org/10.1016/S0022-3476(96)70024-0 DOI: https://doi.org/10.1016/S0022-3476(96)70024-0
Goren MR, Ceyhan E, Ozer C, et al. The impact of reflux pressure on renal scarring in children with sterile vesicoureteral reflux. J Pediatr Urol. 2023;19(1):130.e1–130.e5. https://doi.org/10.1016/j.jpurol.2022.09.016 DOI: https://doi.org/10.1016/j.jpurol.2022.09.016
Sargent MA. What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol. 2000;30(9):587–593. https://doi.org/10.1007/s002470000263 DOI: https://doi.org/10.1007/s002470000263
Hannula A, Venhola M, Renko M, et al. Vesicoureteral reflux in children with suspected and proven urinary tract infection. Pediatr Neph-rol. 2010;25(8):1463–1469. https://doi.org/10.1007/s00467-010-1542-x DOI: https://doi.org/10.1007/s00467-010-1542-x
Lebowitz RL, Olbing H, Parkkulainen KV, et al. International system of radiographic grading of vesicoureteric reflux. International reflux study in children. Pediatr Radiol. 1985;15(2):105–109. https://doi.org/10.1007/BF02388714 DOI: https://doi.org/10.1007/BF02388714
Elder JS, Peters CA, Arant BS, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol. 1997;157(5):1846–1851. https://doi.org/10.1016/S0022-5347(01)64882-1 DOI: https://doi.org/10.1016/S0022-5347(01)64882-1
Swerkersson S, Jodal U, Sixt R, et al. Relationship among vesicoureteral reflux, urinary tract infection and renal damage in children. J Urol. 2007;178(2):647–651. https://doi.org/10.1016/j.juro.2007.04.004 DOI: https://doi.org/10.1016/j.juro.2007.04.004
Gnech M, ’T Hoen L, Zachou A, et al. Update and summary of the European Association of Urology/European Society of Paediatric Urology Paediatric Guidelines on vesicoureteral reflux in children. Eur Urol. 2024;85(5):433-442. DOI: https://doi.org/10.1016/j.eururo.2023.12.005
Austin PF, Bauer SB, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2014;191(6):1863.e13–1865.e13. https://doi.org/10.1016/j.juro.2014.01.110 DOI: https://doi.org/10.1016/j.juro.2014.01.110
Sillén U. Vesicoureteral reflux in infants. Pediatr Nephrol. 1999;13(4):355–361. https://doi.org/10.1007/s004670050625 DOI: https://doi.org/10.1007/s004670050625
Karami H, Razi A, Mazloomfard MM, et al. Is there any role for urodynamic study in children with high-grade vesicoureteral reflux? Urol-ogy. 2012;79(4):888–891. https://doi.org/10.1016/j.urology.2011.06.057 DOI: https://doi.org/10.1016/j.urology.2011.06.057
Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol. 1998;160(3 Part 2):1019–1022. https://doi.org/10.1016/S0022-5347(01)62686-7 DOI: https://doi.org/10.1016/S0022-5347(01)62686-7
Sillen U, Bachelard M, Hansson S, et al. Video cystometric recording of dilating reflux in infancy. J Urol. 1996;155(5):1711–1715. https://doi.org/10.1016/S0022-5347(01)66179-2 DOI: https://doi.org/10.1016/S0022-5347(01)66179-2
Taskinen S, Rintala R. Post-pyelonephritic renal scars are not associated with high voiding pressures. J Pediatr Urol. 2007;3(1):40–44. https://doi.org/10.1016/j.jpurol.2006.01.015 DOI: https://doi.org/10.1016/j.jpurol.2006.01.015
Stenberg A, Läckgren G. Treatment of vesicoureteral reflux in children using stabilized non-animal hyaluronic acid/dextranomer gel (NASHA/DX): a long-term observational study. J Pediatr Urol. 2007;3(2):80–85. https://doi.org/10.1016/j.jpurol.2006.08.001 DOI: https://doi.org/10.1016/j.jpurol.2006.08.001
Stenbäck A, Olafsdottir T, Sköldenberg E, et al. Proprietary non-animal stabilized hyaluronic acid/dextranomer gel (NASHA/Dx) for endo-scopic treatment of grade IV vesicoureteral reflux: Long-term observational study. J Pediatr Urol. 2020;16(3):328.e1–328.e9. https://doi.org/10.1016/j.jpurol.2020.04.008 DOI: https://doi.org/10.1016/j.jpurol.2020.04.008
Karasu AFG, Cetin C, Pasin Ö, et al. Prevalence of urinary incontinence and anal incontinence: an internet-based cross-sectional study of female Turkish University students. Int Urogynecol J. 2023;34(9):2309–2315. https://doi.org/10.1007/s00192-023-05573-7 DOI: https://doi.org/10.1007/s00192-023-05573-7
Osama M, Shaukat S, Javed M, et al. Prevalence of urinary incontinence among young female adults. JPMA J Pak Med Assoc. 2022;72(11):2283–2287.
Sillen U, Hansson S, Jernmark S, et al. Longitudinal follow-up of bladder function in children who participated in the Swedish Reflux Trial. J Pediatr Urol. 2024;20(1):118–126. https://doi.org/10.1016/j.jpurol.2023.08.024 DOI: https://doi.org/10.1016/j.jpurol.2023.08.024
Läckgren G, Cooper CS, Neveus T, et al. Management of vesicoureteral reflux: what have we learned over the last 20 years? Front Pedi-atr. 2021;9:650326. https://doi.org/10.3389/fped.2021.650326 DOI: https://doi.org/10.3389/fped.2021.650326
Tekgül S, Riedmiller H, Hoebeke P, et al. EAU Guidelines on vesicoureteral reflux in children. Eur Urol. 2012;62(3):534–542. https://doi.org/10.1016/j.eururo.2012.05.059 DOI: https://doi.org/10.1016/j.eururo.2012.05.059
Akhavizadegan H, Locke JA, Stothers L, et al. A comprehensive review of adult enuresis. Can Urol Assoc J. 2019;13(8):282–287. https://doi.org/10.5489/cuaj.5485 DOI: https://doi.org/10.5489/cuaj.5485
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Thora S. Olafsdottir, Sofia Tjernlund, Göran Läckgren, Nele Brusselaers, Tryggve Nevéus

This work is licensed under a Creative Commons Attribution 4.0 International License.
As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY license, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.

