Vescico Ureteral Reflux
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Defined as reflux of urine from the bladder cavity up into the
ureters and sometimes into the renal pelvis, vesicoureteral reflux
occurs during voiding or with elevation of pressure in the bladder.
Vesicoureteral reflux is common among children with anatomic abnormalities
of the urinary tract as well as among children with anatomically
normal but infected urinary tracts. In the latter group, reflux
disappears with advancing age and is probably attributable to factors
other than UTI. Long-term follow-up of children with UTI who have
reflux has established that renal damage correlates with marked
reflux, not with infection.
Vesicoureteral reflux (VUR) is the abnormal flow of urine from
the bladder back into the ureters. Urine normally flows in one direction
-- down from the kidneys, through tubes called ureters, to the bladder.
VUR is most commonly diagnosed in infancy and childhood after the
patient has a urinary tract infection (UTI). About one-third of
children with UTI are found to have VUR. VUR can lead to infection
because urine that remains in the child's urinary tract provides
a place for bacteria to grow. But sometimes the infection itself
is the cause of VUR.
There are two types of VUR. Primary VUR occurs when a child is
born with an impaired valve where the ureter joins the bladder.
This happens if the ureter did not grow long enough during the child's
development in the womb. The valve does not close properly, so urine
backs up (refluxes) from the bladder to the ureters, and eventually
to the kidneys. This type of VUR can get better or disappear as
the child gets older. The ureter gets longer as the child grows,
which improves the function of the valve.
Secondary VUR occurs when there is a blockage anywhere in the urinary
system. The blockage may be caused by an infection in the bladder
that leads to swelling of the ureter. This also causes a reflux
of urine to the kidneys.
Infection is the most common symptom of VUR. As the child gets
older, other symptoms may appear, such as bedwetting, high blood
pressure, protein in the urine, and kidney failure.
Common tests to show the presence of urinary tract infection include
urine tests and cultures. Pictures of the urinary system (cystourogram)
may then be needed to determine whether a defective structure in
the urinary tract is the underlying cause of the VUR and infection.
The goal for treatment of VUR is to prevent any kidney damage from
occurring. Infections should be treated at once with antibiotics
to prevent the infection from moving into the kidneys. Antibiotic
therapy usually corrects reflux caused by infection. Sometimes surgery
is needed to correct primary VUR.