- By sahlhealth
- May 18, 2021
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Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux is the abnormal flow of urine from your bladder back up the tubes (ureters) that connect your kidneys to your bladder. Normally, urine flows only down from your kidneys to your bladder. Vesicoureteral reflux is usually diagnosed in infants and children. The disorder increases the risk of urinary tract infections, which, if left untreated, can lead to kidney damage. Vesicoureteral reflux can be primary or secondary. Children with primary Vesicoureteral reflux are born with a defect in the valve that normally prevents urine from flowing backward from the bladder into the ureters. Secondary Vesicoureteral reflux occurs due to a urinary tract malfunction, often caused by abnormally high pressure inside the bladder.Children may outgrow primary Vesicoureteral reflux. Treatment, which includes medication or surgery, aims at preventing kidney damage.
-Urinary tract infections commonly occur in people with Vesicoureteral reflux. A urinary tract infection (UTI) doesn't always cause noticeable signs and symptoms, though most people have some.
These signs and symptoms can include:
- A strong, persistent urge to urinate
- A burning sensation when urinating
- Passing frequent, small amounts of urine
- Blood in the urine (hematuria) or cloudy, strong-smelling urine
- Pain in your side (flank) or abdomen
- Hesitancy to urinate or holding urine to avoid the burning sensation
-A UTI may be difficult to diagnose in children, who may have only nonspecific signs and symptoms. Signs and symptoms in infants with a UTI may also include:
- An unexplained fever
- Lack of appetite
- As your child gets older, untreated Vesicoureteral reflux can lead to:
- Constipation or loss of control over bowel movements
- High blood pressure
- Protein in urine
- Kidney failure
-Another indication of Vesicoureteral reflux, which may be detected before birth by sonogram, is swelling of the kidneys or the urine-collecting structures of one or both kidneys (hydronephrosis) in the fetus, caused by the backup of urine into the kidneys.
-Treatment options for Vesicoureteral reflux depend on the severity of the condition. Children with mild cases of primary Vesicoureteral reflux may eventually outgrow the disorder.In this case, your doctor may recommend a wait-and-see approach.
For more severe Vesicoureteral reflux, treatment options include:
-UTIs require prompt treatment with antibiotics to keep the infection from moving to the kidneys. To prevent UTIs, doctors may also prescribe antibiotics at a lower dose than for treating an infection.A child being treated with medication needs to be monitored for as long as he or she is taking antibiotics. This includes periodic physical exams and urine tests to detect breakthrough infections â€” UTIs that occur despite the antibiotic treatment â€” and occasional radiographic scans of the bladder and kidneys to determine if your child has outgrown Vesicoureteral reflux.
-Surgery for Vesicoureteral reflux repairs the defect in the valve between the bladder and each affected ureter. A defect in the valve keeps it from closing and preventing urine from flowing backward.
Methods of surgical repair include:
- Open surgery. Performed using general anesthesia, this surgery requires an incision in the lower abdomen through which the surgeon repairs the malformation that's causing the problem.This type of surgery usually requires a few days' stay in the hospital, during which a catheter is kept in place to drain your child's bladder. Vesicoureteral reflux may persist in a small number of children, but it generally resolves on its own without need for further intervention.
- Robotic-assisted laparoscopic surgery. Similar to open surgery, this procedure involves repairing the valve between the ureter and the bladder, but it's performed using small incisions. Advantages include smaller incisions and possibly less bladder spasms than open surgery. But, preliminary findings suggest that robotic-assisted laparoscopic surgery may not have as high of a success rate as open surgery. The procedure was also associated with a longer operating time, but a shorter hospital stay.
- Endoscopic surgery. In this procedure, the doctor inserts a lighted tube (cystoscope) through the urethra to see inside your child's bladder, then injects a bulking agent around the opening of the affected ureter to try to strengthen the valve's ability to close properly.This method is minimally invasive compared with open surgery and presents fewer risks, though it may not be as effective. This procedure also requires general anesthesia, but generally can be performed as outpatient surgery.
-Your urinary system includes your kidneys, ureters, bladder and urethra. All play a role in removing waste products from your body.The kidneys, a pair of bean-shaped organs at the back of your upper abdomen, filter waste, water and electrolytes â€” minerals, such as sodium, calcium and potassium, that help maintain the balance of fluids in your body â€” from your blood.Tubes called ureters carry urine from your kidneys down to your bladder, where it is stored until it exits the body through another tube (the urethra) during urination.
Vesicoureteral reflux can develop in two forms, primary and secondary:
- Primary Vesicoureteral reflux. The cause of this more common form is a defect that's present before birth (congenital). The defect is in the functional valve between the bladder and a ureter that normally closes to prevent urine from flowing backward.As your child grows, the ureters lengthen and straighten, which may improve valve function and eventually resolve the reflux. This type of Vesicoureteral reflux tends to run in families, which indicates that it may be genetic, but the exact cause of the defect is unknown.
- Secondary Vesicoureteral reflux. The cause of this form of reflux is most often from failure of the bladder to empty properly, either due to a blockage or failure of the bladder muscle or damage to the nerves that control normal bladder emptying.
-Risk factors for Vesicoureteral reflux include:
Siblings of children who have the condition also are at higher risk, so your doctor may recommend screening for siblings of a child with primary Vesicoureteral reflux.
- Bladder and bowel dysfunction (BBD). Children with BBD hold their urine and stool and experience recurrent urinary tract infections, which can contribute to vesicoureteral reflux.
- Race. White children appear to have a higher risk of Vesicoureteral reflux.
- Sex. Generally, girls have about double the risk of having this condition as boys do. The exception is for Vesicoureteral reflux that's present at birth, which is more common in boys.
- Age. Infants and children up to age 2 are more likely to have Vesicoureteral reflux than older children are.
- Family history. Primary Vesicoureteral reflux tends to run in families. Children whose parents had the condition are at higher risk of developing it.
-Kidney damage is the primary concern with Vesicoureteral reflux. The more severe the reflux, the more serious the complications are likely to be.
-Complications may include:
- Kidney (renal) scarring. Untreated UTIs can lead to scarring, also known as reflux nephropathy, which is permanent damage to kidney tissue. Extensive scarring may lead to high blood pressure and kidney failure.
- High blood pressure (hypertension). Because the kidneys remove waste from the bloodstream, damage to your kidneys and the resultant buildup of wastes can raise your blood pressure.
- Kidney failure. Scarring can cause a loss of function in the filtering part of the kidney. This may lead to kidney failure, which can occur quickly (acute kidney failure) or may develop over time (chronic kidney disease).