Vesicoureteral Reflux Causes, Symptoms, Diagnosis, Treatment, Prevention

Vesicoureteral Reflux Causes, Symptoms, Diagnosis, Treatment, Prevention


What is vesicoureteral reflux?


Vesicoureteral reflux is the backward flow of urine. The urine flows from the bladder back into the kidney.

Urine normally flows from the kidneys. It passes through tubes called ureters. It then flows into the bladder. Each ureter connects to the bladder in a way that prevents urine from flowing back up the ureter. It is similar to a one-way valve. When this does not work properly, or if the ureters do not extend far enough into the bladder, urine may flow back up to the kidney. If the urine contains bacteria, the kidney may become infected. The backup can also put extra pressure on the kidney. This can cause kidney damage.

Vesicoureteral Reflux Causes, Symptoms, Diagnosis, Treatment, Prevention
Vesicoureteral Reflux


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 is due to a urinary tract malfunction, often caused by infection.

This is a potentially serious condition that requires care from your doctor. The sooner Vesicoureteral Reflux is treated, the better the outcome. If you suspect you or your child has this condition, contact your doctor immediately.

What causes vesicoureteral reflux?


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 — minerals, such as sodium, calcium and potassium, that help maintain the balance of fluids in your body — 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 the 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 is a blockage or malfunction in the urinary system. The blockage most commonly results from recurrent urinary tract infections, which may cause swelling of a ureter.

Vesicoureteral Reflux Risks


The following factors increase your chance of developing Vesicoureteral Reflux:

  • Family history
  • Congenital abnormalities of the urinary tract
  • Birth defects that affect the spinal cord, such as Spina Bifida
  • Tumors in the spinal cord or pelvis
  • Spinal cord injury

What are the symptoms of Vesicoureteral Reflux?


A urinary tract infection  is the most common indication of vesicoureteral reflux. A urinary tract infection 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
  • Fever
  • Abdominal or flank pain
  • Hesitancy to urinate or holding urine to avoid the burning sensation
A urinary tract infection may be difficult to diagnose in children, who may have only nonspecific signs and symptoms. Signs and symptoms in infants with a urinary tract infection may also include:

  • Diarrhea
  • Lack of appetite
  • An unexplained fever
  • Irritability
As your child gets older, untreated vesicoureteral reflux can lead to other signs and symptoms, including:

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.

How is Vesicoureteral Reflux diagnosed?


Vesicoureteral Reflux is usually diagnosed when a urinary tract infection is suspected. Your doctor will ask about the history of your child's symptoms and do a physical exam.

The following tests may be recommended if urinary tract infection is suspected:

  • A urine culture, to check for a urinary tract infection
  • Ultrasound of the kidneys. This test uses sound waves to find out the size and shape of the kidneys. It can't detect reflux.
  • Cystourethrogram (cystogram) after the urinary tract infection has been treated. This test can detect Vesicoureteral Reflux and help find out if it's mild or severe. The voiding cystourethrogram, for example, uses an X-ray to take pictures of the urinary tract camera. The bladder is filled with dye, and pictures are taken of the bladder as it fills and empties.
Vesicoureteral Reflux can be passed down from parent to child (inherited). If one of your children has Vesicoureteral Reflux, you may want to ask your doctor to check if your other children have it too. Checking for Vesicoureteral Reflux in siblings is especially helpful if your other child also has urinary tract infections. Doctors can use a cystourethrogram to see if babies who have a sibling or parent with Vesicoureteral Reflux also have the condition. But experts disagree about screening for Vesicoureteral Reflux, because the test involves going into the body.

How to Treat Vesicoureteral Reflux?


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 will likely recommend a wait-and-see approach. During this time, it will be important for you to be watchful for potential urinary tract infections and to seek prompt treatment.

Children with moderate to severe primary vesicoureteral reflux have two treatment options: medication and surgery. Using medication is more common, with surgery usually reserved for those children for whom antibiotics aren't successful.

However, surgery may be a first line therapy for grades IV and V or for families who prefer a quicker, more definitive treatment than medication.

Medications


Urinary tract infections require prompt treatment with antibiotics to keep the infection from moving to the kidneys. Doctors may also use antibiotics to prevent urinary tract infections, usually at about half the dose for treating an infection.

Commonly used antibiotics for prevention include the combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra), trimethoprim (Primsol) and nitrofurantoin (Furadantin, Macrobid, Macrodantin). Some people may be allergic to one or more of these medications, preventing their use. Possible side effects of long-term use of these drugs include:

  • Nausea and vomiting
  • Abdominal pain
  • Increased antibiotic resistance, in which the infection no longer responds to antibiotics and becomes more difficult to treat
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 — urinary tract infection Is that occur despite the antibiotic treatment — and occasional radiographic scans of the bladder and kidneys to determine if your child has outgrown vesicoureteral reflux.

Surgery


Surgery for vesicoureteral reflux repairs the defect in the functional valve between the bladder and each affected ureter that keeps it from closing and preventing urine from flowing backward. There are two methods of surgical repair:

  • 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. Risks include infection, blood clots and bleeding.
  • 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.

How to Prevent Vesicoureteral Reflux?


Vesicoureteral Reflux can not be prevented. However, further complications can be avoided:

  • Seek prompt treatment for bladder or kidney infections.
  • This is particularly true if you have a neurogenic bladder.