Vesicoureteric reflux and urolithiasis in the paediatric population: causality, correlation or no connection at all?

Abstract

Purpose To investigate the potential influence of vesicoureteral reflux (VUR) on stone formation in children by evaluating causality in terms of temporal coincidence, corresponding laterality, presence of UTI and stone composition. Methods Retrospective data analysis was conducted on pediatric patients with stones (group 1) and those diagnosed with VUR (group 2). Data comprises demographics, voiding cysto-urethrograms (VCUGs) stone characteristics, and UTI history. Results In Group 1 (73 stone patients, mean age 8.8 years), VUR was diagnosed in 26% of VCUGs (8/31), predominantly in children under 3 years. Only in a minority of 6%, VUR may be causally linked to infection-stones (2/31). In Group 2 (1758 VUR patients, mean age 3.6 years), 0.5% were found to have stones (9/1758), with VUR potentially contributing to stone formation in 0.34% of cases. VUR in stone patients was low grade, except one child with neurogenic bladder and bilateral grade 4 VUR. Conclusion An association between VUR and stone formation occurs in very young children and appears incidental rather than causal. Metabolic factors play a more significant role for stone formation. Children with stones need not routinely be subjected to a VCUG.