1985 Volume 76 Issue 12 Pages 1855-1868
X-ray fluoroscopic cystometry (CG-CM) was carried out on 12 cases of pediatric vesicoureteral reflux (VUR) including 7 cases of non-obstructive VUR and 5 cases of neurogenic bladder (total 18 reters). The following results were obtained.
1) The classification of VUR with CG-CM in the past reports was not based on analyses of cystometrogram (CMG) and not suitable for actual cases. A new classification to follow was proposed: Type I (low pressure reflux) during the resting pressure on CMG, Type II (high pressure reflux) at the voiding reflex and Type III (high pressure reflux) at the voluntary voiding with abdominal pressure.
2) The average intravesical pressure at the initiation of VUR was 25.6 mmHg in Type I, 41.4mmHg in Type II and 86.3mmHg in Type III. The average vesical capacity in the same period was 387.9ml in Type I, 245.6ml in Type II and 53.3ml in Type III. Non-obstructive VUR tended to have a large vesical capacity, while neurogenic bladder a smaller one.
3) Grading at the initiation of VUR with this study differed from the one with one-shot cystogram or voiding cystourethrogram which had been performed for the screening. There remains the problem what the real grade of VUR is in the process of occurrence of VUR. Functional grading including timing of VUR, however, is prossible with CG-CM.
4) Comparing the grade of VUR with that of hydronephrosis on respective type of VUR, both parameters were coincident in Type I. However, there was dissociation of them in Type II and Type III: the grade of hydronephrosis tended to be milder than that of VUR.
5) In relation of respective type of VUR to CMG, normal pattern or flaccid bladder was found in most of Type I, the number of spastic bladder or uninhibited bladder, however, increased in Types II and III.
6) The ultimate aim of this study is to determine the therapeutic policy for pediatric VUR. Although distinct conclusions were not drawn from this study due to the paucity of clinical cases, the following tendency was recognized. Course observation should be adopted in the low grade VUR of Type I, while surgical therapy would be necessary in the high grade one and the percentage of conservative therapy increased in Types II and III.
