Identification of Filling Versus Voiding Reflux as Predictor of Clinical Outcome

ObjectivesIn children diagnosed with vesicoureteral reflux (VUR), the identification of reflux is made during either the filling (filling reflux) or voiding (voiding reflux) phase of the voiding cystourethrogram. A retrospective study was performed to determine whether this radiologic distinction has prognostic significance.MethodsA retrospective chart review was performed of patients who had undergone voiding cystourethrography from July 1999 to June 2004. Patient age, sex, and reflux grade (unilateral and bilateral) were independently examined in relation to spontaneous resolution, surgical intervention, or observation. These data were subjected to chi-square, analysis of variance with post hoc test, and Kaplan-Meier analysis.ResultsThe diagnosis of primary VUR was identified in 218 patients, and sufficient chart information and hardcopy films to permit identification of filling versus voiding reflux were available for 201. Of 201 patients, 115 (57%) had filling reflux and 86 (43%) had voiding reflux. Of the 115 with filling reflux, 53 (46%) underwent surgery and 27 (23%) had spontaneous resolution (P <0.001). Of the 86 patients with voiding reflux, 12 (14%) underwent surgery and 57 (66%) had spontaneous resolution (P <0.0001). Advanced age and grade of reflux were independently associated with surgical intervention (P <0.0001 and P <0.04, respectively).ConclusionsOur results have shown that VUR that is first identified during the filling phase of the initial voiding cystourethrogram is more likely to require surgical intervention. In contrast, VUR that is first identified during the voiding phase was independently associated with a greater rate of spontaneous resolution. This radiologic distinction, in addition to reflux grade, might be useful in predicting the clinical outcome for children diagnosed with primary VUR.