Vesicoureteral reflux


Vesicoureteral reflux

Description, Causes and Risk Factors:

Backward flow (retrograde) of urine from bladder into ureter. The overall incidence of vesicoureteral reflux is estimated to be around 19.7%. The disease is more common in children.

Vesicoureteral reflux is the retrograde flow of urine from the bladder to the ureter, often extending into the renal pelvis, calyces, and collecting ducts. In patients with vesicoureteral reflux, the ureterovesical junction fails to function as a one-way valve, predisposing patients to pyelonephritis by facilitating the spread of bacteria from the lower urinary tract to the kidneys. The inflammatory and immune response to infection can result in renal scarring.

Vesicoureteral reflux may be primary or secondary, with primary vesicoureteral reflux being the most common form.

    Primary vesicoureteral reflux is reflux in an otherwise normally functioning lower urinary tract - i.e., when outflow obstruction and neurogenic bladder are excluded.

  • Secondary vesicoureteral reflux is reflux that is associated with, or caused by, high intravesical pressures accompanying an obstructed or poorly functioning lower urinary tract, as seen with posterior urethral valves or a neurogenic bladder.

Vesicoureteral reflux is also related to shortened mucosal tunnel length at the uterovesical junction, which allows retrograde flow of urine from the bladder into the ureters. Vesicoureteral reflux can be passed down from parent to child (inherited). If one of your children has vesicoureteral reflux, then the probability of having vesicoureteral reflux to the other child is likely.

Symptoms:

Symptoms include,

    Burning with urination.

  • Frequent urination.

  • Urinary insufficiency.

  • Fever.

  • Weakness.

  • Myalgias.

Diagnosis:

Vesicoureteral refluxis usually diagnosed when a urinary tract infection (UTI) is suspected. Your doctor will ask about the history of your child's symptoms and do a complete physical exam.

The following tests may be recommended if UTI is suspected:

    A urine culture, to check for a UTI.

  • Ultrasound of the kidneys. This test uses sound waves to find out the size and shape of the kidneys. It can't detect reflux.

  • Cystourethrogram (cystogram) after the UTI has been treated. This test can detect vesicoureteral refluxand help find out if it's mild or severe. The voiding cystourethrogram, for example, uses an X-ray to take pictures of the urinary tract. The bladder is filled with dye, and pictures are taken of the bladder as it fills and empties.

Treatment:

Many children do not need treatment for vesicoureteral reflux. The ureters grow as a child gets older. Mild cases of vesicoureteral reflux usually go away completely by the time a child is 5 years old.

If treatment is needed, antibiotics, such as amoxicillin or trimethoprim-sulfamethoxazole (for e.g., Bactrim®, SeptraTM), are often prescribed. Antibiotics prevent or treat infection and help reduce the chance of scarring that can lead to kidney damage. Your child may need to take continuous antibiotic treatment. Or your doctor may give you the option of carefully watching your child for signs of another urinary tract infection and only using antibiotics when he or she gets a new infection. Frequent tests may be needed to check for bacteria in the urine.

Surgery may be needed to repair more severe cases of vesicoureteral reflux. A surgeon may need to create new valves for the ureters to prevent the backflow of urine. Surgery may also be needed if your child has repeated urinary tract infections while taking antibiotics.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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