VESICO URETERAL
REFLUX
VUR implies the passage of urine into
the ureter and kidney during micturition.
Normally the long submucosal and intra
vascular segment of the ureter at the
ureterovesical junction closes when bladder
contracts, effectively preventing VUR.
It is an abnormal retrograde
flow of bladder urine into the
ureters. Urine normally
travels from the kidneys via
the ureters to the bladder. In
the refluxvesicoureteral
flow urineofdirection is
.reversed
<10% of the population.
17.2-18.5% in children without UTI
In those with UTI the incidence is 70%
Younger children are more prone
It decreases to 15% by the age of 12.
It is more common in males ante-natally, in
later life there is a female preponderance
with 85% of cases.
Vesicoureteral reflux may present
birth prenatal
before hydronephrosis,
abnorma
as an widening of the ureter
l UTI or acuteorpyelonephritis.
a with
It is associated with recurrent
UTI
Newborns may be lethargic with faltering
growth
:UTI
If the
child is with UTI, he may have
pyrexia
dysuria
frequent urination
malodorous urine
Chills
Vomiting
feeling that the bladder does not empty
completely
History Collection & Physical
Examination urinary tract infection
Nuclear cystogram
for subsequent evaluations as there is
less exposure to radiation
Fluoroscopic voiding cysto
urethrogram Grading the initial work
up
Ultrasonic cystography
Abdominal ultrasound
Urethral dialation
urine culture
to check for a UTI
Ultrasound of the kidneys
Primary .1
VURSecondary .2
VUR
.present at birth
It is caused by a defect in the development
of the valve at the end of the tube that
carries urine from the kidneys to the
bladder (ureter). This is the most common
type of VUR and is usually detected shortly
.after birth
occurs when an obstruction in the bladder or
urethra causes urine to flow backward into
.the kidneys
occur at any age and can be caused by
surgery, injury, a pattern of emptying the
bladder that's not normal, or a past infection
that puts pressure on the bladder. It is more
common in children who have other birth
.defects, such as spina bifida
International Classification
Grade I - reflux into non-dilated ureter
Grade II - reflux into the renal pelvis and calyces
without dilatation
Grade III - mild/moderate dilatation of the ureter, renal
pelvis and calyces with minimal blunting of the
fornices
Grade IV – dilation of the renal pelvis and calyces with
moderate ureteral tortuosity
Grade V – gross dilatation of the ureter, pelvis and
calyces; ureteral tortuosity; loss of papillary
impressions
Goal
- to minimize infections,renal injuryand
other complications of reflux.
In newborn & infants , prophylactic antibiotics
In older children, bowel and bladder
management
Good perineal hygiene, and timed and double
voiding are also important aspects of medical
treatment. Bladder dysfunction is treated with
the administration of anticholinergics.
Deflux is a gel that is used in endoscopic
injections to treat Vesicoureteral Reflux. Deflux
consists of two types of sugar-based molecules
called dextranomer and hyaluronic acid. Both
materials are also biocompatible, which means
that they do not cause significant reactions
within the body. Hyaluronic acid is produced
and found naturally within the body.
A surgical approach is necessary in cases where
a breakthrough infection results despite
prophylaxis.
There are three types of surgical procedures
endoscopic (STING/HIT procedures)
laparoscopic
open procedures (Cohen procedure,
Leadbetter- Politano procedure).
Annual evaluation
Blood
pressure, weight, height, VCU,
urine culture
