Cetin Nuran, Kavaz Tufan Aslı, Tokar Baran
Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Department of Pediatric Urology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Low Urin Tract Symptoms. 2021 Jan;13(1):160-167. doi: 10.1111/luts.12349. Epub 2020 Oct 5.
Functional urinary incontinence is often associated with recurrent urinary tract infection (UTI), vesicoureteral reflux (VUR), and renal scarring. This study aims to evaluate the correlations between urodynamic findings and recurrence of UTI, VUR, and renal scarring in children with functional incontinence.
In this retrospective observational study, data on the presence of VUR, urodynamics and 99Tc-dimercaptosuccinic acid scintigraphy findings, and episodes of febrile UTI were obtained from patients' records. The patients had at least 3 years of follow-up.
There were significant associations between recurrence of UTI and decreased bladder capacity (hazard ratio: 1.321, P = .028). The receiver operator characteristic curve analysis showed a cutoff value for compliance of 13.25 mL/cmH O for renal scarring (P = .000). There was a significant association between bladder wall thickening and VUR (odds ratio: 2.311, P = .008). The compliance had a cutoff value of 14.7 mL/cm H O (P = .023) for severe VUR. The frequency of renal scarring was higher in patients with severe VUR and dysfunctional voiding (P = .001 and P = .041, respectively). The independent risk factors for renal scarring were low compliance, severe VUR, and dysfunctional voiding in children with functional incontinence, but recurrence of febrile UTI was not a risk factor for renal scarring. Decreased bladder capacity was a risk factor for recurrence of febrile UTI.
The present study suggests that low compliance, severe VUR, and dysfunctional voiding, but not the recurrence of febrile UTI, are the independent risk factors for renal scarring in children with functional incontinence, and decreased bladder capacity is the risk factor for the recurrence of febrile UTI.
功能性尿失禁常与复发性尿路感染（UTI）、膀胱输尿管反流（VUR）及肾瘢痕形成相关。本研究旨在评估功能性尿失禁患儿尿动力学检查结果与UTI复发、VUR及肾瘢痕形成之间的相关性。
在这项回顾性观察研究中，从患者记录中获取了VUR存在情况、尿动力学和99Tc-二巯基丁二酸闪烁扫描结果以及发热性UTI发作的数据。患者至少随访了3年。
UTI复发与膀胱容量减小之间存在显著关联（风险比：1.321，P = 0.028）。受试者工作特征曲线分析显示肾瘢痕形成的顺应性截断值为13.25 mL/cmH₂O（P = 0.000）。膀胱壁增厚与VUR之间存在显著关联（优势比：2.311，P = 0.008）。严重VUR的顺应性截断值为14.7 mL/cmH₂O（P = 0.023）。严重VUR和排尿功能障碍患者的肾瘢痕形成频率更高（分别为P = 0.001和P = 0.041）。功能性尿失禁患儿肾瘢痕形成的独立危险因素为顺应性低、严重VUR和排尿功能障碍，但发热性UTI复发不是肾瘢痕形成的危险因素。膀胱容量减小是发热性UTI复发的危险因素。
本研究表明，顺应性低、严重VUR和排尿功能障碍而非发热性UTI复发是功能性尿失禁患儿肾瘢痕形成的独立危险因素，膀胱容量减小是发热性UTI复发的危险因素。
