What is Vesico Ureteral Reflux?
Vesico ureteral reflux is the abnormal back flow of urine from the bladder into the ureter and up to the kidney. It is the most common problem found in children with urinary tract infections. Reflux is dangerous because it allows bacteria that might be in the bladder to reach the kidney. This can cause a kidney infection (pyclonephritis) which potentially can lead to kidney scarring and / or damage. About 1% of children in the world have VUR.
Why does reflux occur?
Normally ureter enters the bladder (the bladder is made out of muscle) in such a way that urine is allowed to enter the bladder but not allowed to back up to the kidney. Reflux occurs when the ureter enter the bladder abnormally. As a result, the muscle backing of the bladder doesn't completely cover the ureter and urine is appropriately is allowed back towards the kidney.
Reflux can occur due to non-anatomical reasons like dysfunctional voiding, neurogenic bladder or other secondary causes.
Is VUR serious?
Using x-rays of the urinary system, your health care provider can tell you how serious your child's VUR with a grading scale. This scale ranges from grade 1 (mild) to grade 5 (severe). most of the time, milder grades of VUR will resolve on their own. However the more severe the VUR, the less likely it will go away on its own
There can be serious consequence of VUR. Kidney infections can occur when infected urine flows backs in to the kidney's. these infections can lead to scaring and damage to the kidney's. this damage can cause poor kidney function & high blood pressure later in life.
Damage and /or scaring that may have resulted from a previous urinary tract infection.
How is reflux diagnosed?
VUR is diagnosed using an X-ray of the bladder. This X-ray is called voiding cystourethrogram (VCUG). in the VCUG test a thin soft tube (catheter) is placed in the bladder through the urethra . dye is then placed in to the bladder through the tube. X-ray pictures are taken to see if the dye flows back into the ureter's. the severity of VUR is determined by the amount of urine flowing back through the ureters.
What, if any, other test should be done?
- Ultrasound of the urinary tract - it is usually done prior to VCUG.
- Renal scan - this test is done if the above tests are abnormal or if repeated febrile infections have occurred. It is used to better demonstrate the actual function and / or drainage of the kidneys. A renal scan also show if there is kidney.
This test is very similar to VCUG, however, it has less radiation and is very sensitive for reflux. This test is recommended for subsequent follow-up in the medical management of reflux, after the diagnosis is made by the VCUG. The nuclear cystogram is also used as a screening test for siblings of kids who have reflux.
Is VUR inherited?
VUR runs in families, as many as1/3 of siblings will have VUR. If a parent has VUR, about half of his or her children will also have it. The risk of kidney damage is greatest during the first 6
Years of life. The goal is to find VUR early and prevent infection that could result in kidney damage.
How do I know if my child has an infection signs of urinary tract infection?
- Foul smelling or cloudy urine
- Stomach ache
- Back ache
- Side pain
- Burning or pain when urinating
- Frequent & urgent urination
How is reflux treated?
There are 3 types of management plans. These are based upon the degree of reflux, the age of the child at time of diagnosis, and the severity of urinary tract infections, and the amount of damage to the kidneys seen on x-ray studies.
Three types of treatment for VUR
How does it works
Antibiotics Antibiotics taken every day help to prevent UTI until VUR goes away by itself. This could take years, get more information from your doctor
Endoscopic injection A gel is injected where the ureter joins the bladder so that urine Cannot flow
back up to the kidneys. Surgery The connection between the bladder and ureter is repaired Surgically.
What does it involve
Antibiotics Medicine must be taken every day often for several years
Endoscopic Injection Out patient procedure children normally go home the same day
Surgery Open surgery- children normally have to stay in hospital for a couple of day Will my child be cured
Antibiotics No, your child will need regular followup until VUR goes away by Itself
Endoscopic Injection About 70% of children are cured or improved such that they don't Need any
Surgery About 95% children are cured permanently.
DR. GRIFFIN .M
MBBS, MS (Gen Surgery), M.Ch(Urology)
Consultant Urologist, Andrologist & Kidney Transplant Surgeon
MBBS, MS, Mch (Urology)