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What is vesicoureteral reflux?
Vesicoureteral reflux occurs when urine is in the bladder flows back (reflux) into the ureters and often back into the kidneys. The bladder is the hollow muscular organ that stores urine before urination. The bladder has three small openings: two connect the ureters where urine is drained from the kidneys and one connects the bladder to the urethra where urine exits the body.
The ureters are funnel-shaped tubes that carry urine from the kidneys. The ureters enter the bladder at a diagonal angle and have a one-way valve that normally prevents urine back up the ureters towards the kidneys. When a child has vesicoureteral reflux, the mechanism that prevents urine from non-work, allowing urine to flow in both directions. This condition is most often diagnosed in infancy and childhood. The child with vesicoureteral reflux is at risk of developing recurrent kidney infections, which eventually 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:
* VUR commonly occurs in children whose parents or siblings have the irregularity.
* Children born with neural tube defects such as spina bifida may have VUR.
* During infancy, the disease is more common among boys because as they urinate there is more pressure in the entire urinary tract. The irregularity is more common in girls during early childhood.
* VUR can occur in children with other urinary tract abnormalities such as posterior urethral valves, ureterocele, or ureter duplication.
* The VUR is more common in children Caucasian (white) than 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 common in children under 5 years of age and are rare in men of any age, unless VUR is present).
* Problems with urination including:
or urgency.
or discharge.
or wetting pants.
* Abdominal mass may be detected due to inflammation of the kidneys.
* Poor weight gain.
* High blood pressure.
The symptoms of VUR may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.
How is vesicoureteral reflux diagnosed?
VUR can often be detected by ultrasound before birth. If there is family history of VUR, but the child has no symptoms, the child’s doctor may decide to conduct diagnostic tests to rule out VUR. Diagnostic procedures for VUR may include:
* Voiding cystourethrogram (Also called English is VCUG) – a specific x-ray that examines the urinary tract. It puts a catheter (hollow tube) into the urethra (the tube that drains urine from the bladder to outside the body) and the bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The images show whether there is reflux of urine into the ureters and kidneys.
* Renal ultrasound – a noninvasive test in which a transducer is passed over the kidney producing sound waves that bounce off the kidney, transmitting a picture of the organ on a video screen. The test is used to determine the size and shape of the kidney and to detect masses, stones, cysts or other obstruction or abnormalities.
* Blood tests.
Treatment for vesicoureteral reflux:
VUR can occur in varying degrees of severity. It can cause mild reflux, when urine backs up only a short distance in the ureters. It can cause severe reflux leading to kidney infection or infections and permanent kidney damage. Specific treatment for VUR will be determined by the child’s physician based on:
* The child’s age, overall health and medical history.
* Extent of the condition.
* Child’s tolerance for specific medications, procedures or therapies.
* Expectations for the course of the condition.
* Your opinion or preference.
Your child’s physician may assign a grade classification system (from 1 to 5) to indicate the degree of reflux your child has. The higher grade implies more severe reflux.
Most children with VUR grade 1 to 3 do not need any type of intense therapy. The reflux resolves itself over time, usually within five years.
Children who develop frequent fevers or infections may require ongoing preventative antibiotic therapy and periodic urine tests.
Children with reflux grade 4 and 5 may require surgical intervention. During the procedure the surgeon will create a valve apparatus for the ureter that will prevent backflow of urine into the kidneys. In more severe cases surgery may be necessary to remove the scarred kidney and ureter.
To relieve acid reflux may be taken several measures. Raising the head of the bed about 15 cm, while the person sleeps, can cause the acid to reach into the esophagus. It may be helpful to avoid coffee, alcohol and other substances that strongly stimulate the production of stomach acid. It also follows the ingestion of an antacid, one hour after meals and one at bedtime to neutralize stomach acid and possibly reducing the passage of liquid acid through the lower esophageal sphincter.
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