Clinical usefulness of the non-invasive functional study of the lower urinary tract voiding phase as a predictor of resolution after the first endoscopic treatment of vesico-ureteral reflux in children older than 3 years

Autors de IIS La Fe

• José Antonio March Villalba

  Autor

• Leopoldo Marzullo Zucchet

  Autor

• David Hervás Marín

  Autor

• Alba Polo Rodrigo

  Autor

• Agustin Serrano Durba

  Autor

• Carlos Dominguez Hinarejos

  Autor

• Francisco Boronat Tormo

  Autor

Grups d'Investigació

• Urología

  Leader

  Francisco Boronat Tormo

Abstract

OBJECTIVES: To determine the usefulness of voiding diary (VD), uroflowmetry with electromyography (UF-EMG), bladder wall thickness (before micturition) (VWTUS) and residual urine (PVR) (ultrasound measure) in predicting the outcome of the first endoscopic treatment (1 ENDT) of vesicoureteral reflux (VUR) in children > 3 years. METHODS: Cross-sectional ambispective study of 48 children with vesicoureteral reflux. Those with previous endoscopic treatment, age <4 years, anatomical or neurological abnormalities and a history of urethral or abdominal surgery were excluded. The outcome variable was the correctness (by isotopic cystography) three months after 1 ENDT. Univariate and multivariate analyses were performed through a Multilayer Perceptron network and a logistic regression model Empirical Bayesian penalized type LASSO Elastic net. Diagnostic accuracy were determined. RESULTS: Mean age of the sample was 6.8 +/- 2.28 years. The rate of VUR correction after 1 ENDT was 77%. The variables selected by both methods were: VD-retentionist (OR 3.90), high PVR (OR 2.69), high VWTUS (OR 4.44). Normal OF-E/v1G was a preventive variable (OR 0.38). Diagnostic accuracy (p<0.005): VD (Se=98% Sp=48.7%), UF+EMG (Se=27.3% Sp=94.6%), PVR (Se=72.7% Sp=97.3%) (AUC=0.8 cut point 20 ml), VWTUS (Se=81 .8% Sp=73%) (AUC=0.8 cut point 4.6 mm). There were no statistical differences between PVR and VWTUS. Combined use of UF+EMG+PVR (Se= 90.9% Sp=92%) (p<0.05). CONCLUSIONS: Noninvasive voiding study is useful in predicting the persistence of VUR after 1 ENDT in children > 3 years. After screening with a VD, OF-E/V1G + RPM combination could be useful to detect these patients and propose a treatment that improves bladder voiding function prior to surgery.

Keywords

• Child vesicoureteral reflux; Uroflowmetry; Non-invasive test; Endoscopic treatment