Vesicoureteral Reflux

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Vesicoureteral Reflux

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Vesicoureteral reflux is a structural or congenital condition

Normally, urine travels from the kidneys to the bladder and out of the body. When this process is reversed and urine goes back into the kidneys, it’s a condition referred to as vesicoureteral reflux (VUR). More likely to occur in children and infants, VUR increases the risk of recurring urinary tract infections and damage to the kidneys.

  • Some children outgrow the condition.
  • If this doesn’t happen, treatment usually involves medication or surgery.

Types of VUR and Causes

Tubes called ureters take urine from the kidneys to the bladder for storage. When the bladder is full, urine passes through another tube called the urethra to the outside of the body. A muscle-valve created due to the way the ureter works its way through the bladder wall prevents urine from traveling back up to the kidneys.

There are two types of vesicoureteral reflux that can affect this process. With primary VUR, a defect present at birth prevents the valve that normally prevents back-flow from fully forming. With secondary VUR, nerve damage or a problem with the bladder muscle prevents the bladder from fully emptying. Bladder and bowel dysfunction and a family history of VUR may be contributing factors.

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Symptoms and Signs Associated with VUR

Urinary tract infections are usually the first sign that urine is traveling back into the kidneys. Children with VUR may urinate more frequently, feel a burning sensation when urinating, or feel pain on their sides or in their abdominal area. Signs of vesicoureteral reflux may also include:

  • Cloudy or odorous urine
  • Blood in urine
  • Diarrhea
  • Appetite changes
  • Fever
  • High blood pressure
  • An abdominal mass from kidney swelling
  • Signs of kidney failure

How It’s Diagnosed

After an initial exam, a urinalysis is usually done to look for chemical imbalances suggesting urine backup. Similar to what’s done when viewing a baby during a pregnancy, a sonography may be done to produce images of the bladder and kidneys. With a voiding cystourethrogram, X-ray images of a full and empty bladder are compared to look for abnormalities. The urinary tract is sometimes evaluated with the injection of a radioactive tracer via a catheter with a radionuclide cystogram.

Non-Surgical VUR Treatments

Periodic observation may be all that’s recommended with mild VUR. If symptoms associated with vesicoureteral reflux are more severe, antibiotics are usually prescribed. Children with VUR may be given lower doses of antibiotics when they don’t have an active urinary tract infection to prevent UTIs.

Surgery for Vesicoureteral Reflux

It the reverse urine flow is causing serious problems, surgery may be necessary. Traditional open surgery is performed through the abdomen to correct the defect in the valve. Smaller incisions are used to access the affected area with robotic-assisted laparoscopic surgery. If endoscopic surgery is done, a lighted instrument called a cystoscope is used to inject a bulking agent into the area where the valve forms to strengthen tissues enough to allow it to properly close.

If the condition develops in older children, the most noticeable symptom may be bedwetting (nocturnal enuresis). Should a pediatrician rule out common causes of bedwetting, a referral may be made to a urologist to thoroughly examine the urinary tract, connecting tubes, and kidneys for signs of vesicoureteral reflux.

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