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Objective Measures of Voiding Function in the Vesicoureteral Reflux Population
Katherine Herbst, M.Sc.1, John H. Makari, M.D.2, Renee Silvis, B.S.1, Fernando A. Ferrer, M.D.2, Christina Kim, M.D.2.
1Connecticut Children's Medical Center, Hartford, CT, USA, 2Connecticut Children's Medical Center/University of Connecticut Health Center, Hartford/Farmington, CT, USA.

BACKGROUND:
Dysfunctional Elimination Syndrome (DES) is prevalent in patients with vesicoureteral reflux (VUR). When present, DES may hamper surgical success. Objective measures of DES may not be predictive of disease presence. We preformed an analysis of objective DES measures and how they related to clinical assessment.
METHODS:
Voiding function was prospectively collected in patients undergoing open or robotic ureteral reimplantation, or Deflux injection. Patients were classified as having DES by the clinician (DxDES), DVSS questionnaire (DVSS), and PVR measurement (PVR/EBC). Using DxDES as the gold standard, positive predictive value (PPV), sensitivity, and specificity were calculated for DVSS, and a ROC curve was used to determine the accuracy of PVR/EBC.
RESULTS:
Between June 2010 and February 2012, fifty-one patients were enrolled by two clinicians, and follow-up was available in forty-four. DxDES was seen in twenty-nine patients (57%) preoperatively, and eleven patients (25%) postoperatively. Compared to DxDES, preoperative DVSS score had a PPV of 75%, a sensitivity of 56%, and a specificity of 69%. Postoperative DVSS score had a PPV of 40%, a sensitivity of 36%, and a specificity of 24%. ROC curves for both pre-surgical and follow-up PVR/EBC had area under the curve values of 0.456 and 0.464 respectively.
CONCLUSIONS:
DVSS questionnaire and PVR measurement were not consistent with our clinician's assessment. Although this series has a small sample size, these findings highlight a need to further investigate the value of DVSS and PVR as diagnostic tools, and possibly the development of more accurate objective measures.


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