Vesicoureteral Reflux Causes, Symptoms And Treatments by Dr. Prashant Jain

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Vesicoureteral Reflux Causes, Symptoms
And Treatments by Dr. Prashant Jain
Vesicoureteral Reflux Causes, Symptoms And
Treatments
Kidneys are important organ for urine formation.
Normally, urine flows into the bladder through
ureters. tfowever, in some children, urine from
the bladder flows back through the ureters. This
condition is known as Vesicouretral reflux (VUR)
and is common in infants and children. It can be
unilateral or bilateral. This could cause
infections and damage your kidneys. VUR affects
about 10 of children. Although most can grow out
of this condition, people who have severe cases
may need surgery to protect their kidneys.
This condition should not be ignored as it
damages the function of kidneys and can lead to
high blood pressure later in life. The risk of
kidney damage is greatest during the first 6
years of life.
Causes of VUR
A flap valve is located where the ureter joins
with the bladder. Usually, the valve allows only
a one-way flow of urine from the ureters to the
bladder. Sometimes, a defective flap valve
allows urine to flow backward. This can affect
one or both ureters. This is called primary
vesicoureteral reflux.
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Sometimes VUR can be because of blockage at the
bladder outlet(Posterior urethral valve or
abnormality of the bladder functions (Neurogenic
bladder) that can causes urine to push back into
the ureters.
This back flow of urine is responsible for
recurrent urinary tract infections and damage of
kidney (Renal scarring).
Symptoms
Urinary tract infection is one of the commonest
presentation seen in children younger than the
age of 5.
Common symptoms are

• Foul smelling or cloudy urine
• Fever
• Burning or pain while urinating
• Frequency and urgency of urine
• Vomiting
• Infants may have following symptoms.

• Diarrhoea.
• Poor feeding.
• Fever

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• Increased irritability
• Also ultrasound scan done during pregnancy
  showing swelling in kidneys can be because of
  VUR.

Diagnosis Of VUR
VUR can often be suspected by ultrasound before a
child is born or if child has urinary tract
infection. Ultrasound may show dilatation of
drainage system of kidney (Pelvi-calyceal system
and ureter) called as hydronephrosis, but this
does not prove that reflux is present.
VUR is diagnosed using an X-ray of the bladder
known as voiding cystourethrogram (VCUG). In
this procedure, a thin, soft tube (catheter) is
placed in the bladder through the urethra. Dye is
then introduced into the bladder through the
tube. X-ray pictures are taken to see if the dye
flows back into the ureters. Based upon the
severity, VUR is categorized into five grades.
Milder grade of VUR does not require any
treatment. All infants with urinary tract
infection and other older children with frequent
urinary tract infections with or without
hydronephrosis should a be considered for VCUG
test.
Treatment Options For Management Of VUR
There are 3 main options for managing or treating
VUR. One should understand the risks, benefits,
and follow-up of each treatment.
Antibiotic It is used to prevent infections
until VUR goes away by itself. This treatment
may take several years, and children must take
medication every day. These children need to be
reassessed for VUR and renal damage on regular
basis. tfowever, long term treatment with
antibiotics may cause the bacteria to become
resistant, increasing the risks of recurrent
infections.
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Surgery This type of treatment cures most
children. Surgery is good option for high grade
reflux. This can be performed by open or
laparoscopic technique.
Endoscopic treatment (Deflux Injection) In this
day care procedure, the medication is injected
where the ureter joins the bladder. Deflux is a
safe and effective treatment for VUR. A gel is
introduced into the body where the ureters meet
the bladder. This procedure is performed as a day
care procedure. Deflux gel is placed at the spot
where the ureters connect to the bladder with
the help of a small camera called a cystoscope (a
type of endoscope used to view the bladder).
Eventually, new tissue grows around the gel,
preventing the reflux of urine. Usually, there
will be no pain after the procedure. Deflux is
used for the treatment of all grades of VUR in
children. Many children have success after one
injection while some may need more injection
procedures. tfowever lower the grade of VUR, the
better it works. Also, the procedure works better
for children who have reflux in only one ureter.