VESICOURETERAL REFLUX (VUR)
Vesicoureteral reflux is a condition where urine flows backward from the bladder to the ureters, the tube that connects the kidney to the bladder.
- Urine, which is the liquid by-product of metabolism in humans, normally flows one way.
- It travels down from the kidneys, into the ureter and gets stored in the bladder.
- The urine is then released from the bladder through the urethra during urination.
- With vesicoureteral reflux, the urine flow retrogrades from the bladder, up the ureter to the kidneys.
- The condition is prevalent in infants and young children but may occur in older children and adults.
- Vesicoureteral reflux allows bacteria, which may be present in the urine in the bladder, go up into the kidney. This can lead to scarring, kidney infection, and even long-term damage if left untreated.
- There are two types of VUR, namely: primary VUR, and secondary VUR
CAUSES
A primary vesicoureteral reflux commonly occurs as a result of a defect that is present before birth. This defect is seen in the functional valve located where the ureter joins with the bladder. This valve allows a one-way flow of urine from the ureters to the bladder and normally closes to prevent urine from flowing back. This type tends to run in the family indicating that it may be generic.
A secondary vesicoureteral reflux occurs as a result of pressure that causes urine to flow backward, either due to a blockage somewhere in the urinary system, or damage to the nerve that allows normal bladder emptying.
Certain risk factor includes:
- Urinary abnormalities such as ureter duplication, or bladder exstrophy
- Bladder and bowel dysfunction
- A family history
- Abnormal bladder function such as seen in children with spinal cords or nerve problems
- Age
SYMPTOMS
Many children with the disease do not have symptoms. But when they do, the most common indication is a urinary tract infection caused by bacteria. A urinary tract infection commonly occur in people with the condition.
These symptoms may include:
- Strong urge to urinate
- Pain or burning sensation while urinating
- Fever
- Abdominal pain
- Bloody urine or cloudy, stinking urine
- Passing frequent, small amounts of urine
Untreated vesicoureteral reflux can result in:
- High blood pressure
- Protein in the urine
- Kidney failure
- Bed-wetting
- Poor weight gain
- Scarring of the kidney tissue
DIAGNOSIS AND TREATMENT
The condition is usually diagnosed when a urinary tract infection is suspected. To check for VUR, the doctor will carry out a physical examination and review the child’s family history.
Blood and urine tests may be carried out to check the child’s kidney function as well as look for infections or any kidney damage.
Other tests include:
- Kidney and bladder ultrasound
- Voiding cystourethrogram, an X-ray image of the bladder taken when it is full and when it’s emptying to detect abnormalities.
- A nuclear scan to show if the urinary tract is working perfectly.
SEVERITY
Doctors grade the condition according to the severity of the reflux. In the mildest case, urine backs up only to the ureter while the severe case involves severe kidney swelling and twisting of the ureter. The mildest case is referred to as grade 1, and the severe case is referred to as grade V.
TREATMENT
Treatment options depend on the severity of the condition, age, overall health, and medical history. A doctor may take a wait-and-see approach for children with the mildest case as they may eventually outgrow the disorder.
For severe cases, treatment options may include:
- Medications including antibiotics such as amoxicillin to treat UTIs and prevent the infection from moving to the kidneys.
- A surgical procedure to repair the defect between the valve and the affected ureter, such as open surgery, robotic-assisted laparoscopic surgery, or endoscopic surgery.
Lifestyle remedies including encouraging your child to drink more fluid and providing the child with a warm blanket or towel may help to ease discomfort.