Vesicoureteral Reflux
(VUR)
What is vesicoureteral reflux?
Vesicoureteral
reflux happens when urine dwelling in the bladder flows back into the
ureters and often back into the kidneys. The bladder is the hollow, muscular
organ that stores urine before urination happens. The bladder has 3 small
openings; 2 connect the ureters where urine is drained down from the kidneys,
and 1 connects the bladder to the urethra where urine exits the body.
The
ureters are funnel-shaped tubes that carry urine from the kidneys. Ureters
enter the bladder at a diagonal angle and have a special 1-way valve system
that normally prevents urine from flowing back up the ureters in the direction
of the kidneys. When a child has vesicoureteral reflux, the mechanism that
prevents the backflow of urine does not work, allowing urine to flow in both
directions. This condition is most frequently diagnosed in infancy and
childhood. A child who has vesicoureteral reflux is at risk for developing
recurrent kidney infections. This, over time, can cause damage and scarring to
the kidneys.
What causes vesicoureteral reflux?
There are many different reasons why a child may
develop vesicoureteral reflux. Some of the more common causes include:
·
Having parents or siblings with VUR
·
Being born with neural tube defects like
spina bifida
·
Having other urinary tract abnormalities,
like posterior urethral valves, ureterocele, or ureter duplication
During infancy, the disease is more common among boys
because as they urinate there is more pressure in their entire urinary tract.
In early childhood, the irregularity is more common in girls. VUR is more
common in white children than in African-American children.
What are the symptoms of vesicoureteral reflux?
The following are the most common symptoms of
vesicoureteral reflux. However, each child may experience symptoms differently.
Symptoms may include:
·
Urinary tract infection. Urinary tract
infections are uncommon in children younger than age 5. They are unlikely
in boys at any age, unless VUR is present.
·
Trouble with urination including:
·
Urgency
·
Dribbling
·
Wetting pants
·
A stomach mass from a swollen kidney
·
Poor weight gain
·
High blood pressure
The symptoms of VUR may look like other conditions or
medical problems. Always talk with your child's health care provider for a
diagnosis.
How is vesicoureteral reflux diagnosed?
VUR can often be found by ultrasound before a child is
born. If there is a family history of VUR, but your child has no symptoms, your
child's health care provider may choose to do a diagnostic test to rule
out VUR. Diagnostic procedures for VUR may include:
·
Voiding cystourethrogram
(VCUG). A VCUG is a specific X-ray that examines the
urinary tract. A catheter (hollow tube) is placed in the urethra. This is a
tube that drains urine from the bladder to the outside of the body. The bladder
is filled with a liquid dye. X-ray images will be taken as the bladder fills
and empties. The images will show if there is any reverse flow of urine into
the ureters and kidneys.
·
Renal ultrasound. This is a noninvasive test
in which a transducer is passed over the kidney. It produces sound waves that
bounce off the kidney and transmit a picture of the organ on a video screen.
The test is used to determine the size and shape of the kidney, and to find a
mass, kidney stone, cyst, or other obstruction or abnormalities.
·
Blood tests
What is the treatment for vesicoureteral reflux?
VUR can happen in varying degrees of severity. It can
cause mild reflux, when urine backs up only a short distance in the ureters.
Or, it can cause severe reflux leading to kidney infection(s) and permanent
kidney damage. Specific treatment for VUR will be decided by your child's
health care provider based on:
·
Your child's age, overall health, and medical
history
·
The extent of the condition
·
Your child's tolerance for specific medicines,
procedures, or therapies
·
Expectations for the course of the condition
·
Your opinion or preference
Your child's health care provider may assign a
grading system (ranging from 1 to 5) to indicate the degree of reflux your child
has. The higher the grade, the more severe the reflux.
Most children who have grade 1 through 3 VUR do not
need any type of intense therapy. The reflux resolves on its own over time,
usually within 5 years. Children who develop frequent fevers or infections may
need ongoing preventive antibiotic therapy and periodic urine tests. Surgical
treatment is also available.
Children who have grade 4 and 5 reflux may require
surgery. During the procedure, the surgeon will create a flap-valve apparatus
for the ureter that will prevent reverse flow of urine into the kidney. In more
severe cases, the scarred kidney and ureter may need to be surgically removed.
New treatments are being introduced for vesicoureteral
reflux. Talk with your child's health care provider for more information.
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