In this disease, urine, which should normally flow only from the kidneys to the bladder through the ureters, escapes upward due to the inadequate functioning of the valve structure at the bottom where the ureter opens to the bladder.
What is the prevalence of Vesicoureteral Reflux?
It is a common congenital disorder and its incidence is 1%. This rate is between 30-50% among the children with recurrent urinary tract infections. It occurs in 16% of children with kidney enlargement (hydronephrosis) detected on ultrasound while in the womb. The probability of occurrence in children with VUR in siblings is 27%, while the incidence among the children with VUR in their parents is 35% on average.
Diagnosis
The diagnosis is made during examinations in children who have had febrile urinary tract infections or who have swelling in the kidney (hydronephrosis) while in the womb.
Urination cystourethrography (VCUG): This examination, which is popularly referred to as a catheterized film, is the most important and most informative test to be done in diagnosis. Contrast material is injected into the bladder through the catheter, and the images taken at intervals evaluate whether there is a back leak while the bladder is filling and emptying. If there is vesicoureteral reflux, grading is done on a scale of 1 to 5 according to its severity.
In children diagnosed with vesicoureteral reflux, tests such as urinary ultrasound, renal scintigraphy (DMSA) and urodynamic examination may be required to evaluate the status of the kidney and bladder.
Why is Vesicoureteral Reflux important?
This disease is an anatomical and / or functional disorder that can have serious consequences such as kidney damage, hypertension and kidney failure.
Vesicoureteral reflux does not cause kidney damage among the children who do not have urinary system infection and whose bladder is working properly. For this reason, it is aimed to protect kidney functions by taking measures to reduce the risk of developing kidney infection.
Treatment
Non-Surgical (Conservative) Treatment: The main purpose is to prevent febrile urinary tract infections. Most children with low-grade vesicoureteral reflux heal spontaneously. In the five-year follow-up, it is seen that 80% of those with 1st and 2nd degree reflux and 30-50% of those with 3rd to 5th degree reflux heal spontaneously./p>
Antibiotic prophylaxis: It is the long-term application of lower doses of antibiotics for preventive purposes in order to prevent the urine from becoming infected.
Urination training: It should be ensured that the child goes to the toilet every 2-3 hours at home and at school and urinates regularly. In order for the pelvic floor muscles of the child to relax and the bladder and intestines to fully empty, the child should sit in the appropriate position on the toilet, his/her feet should be on the ground, and if necessary, support should be placed under his/her feet. Fluid intake should be evenly distributed throughout the day. If there is a constipation problem, it must be resolved.
Early circumcision in boys is part of the conservative approach as it protects them from infection.
Surgical Treatment
- Endoscopic injection of fillers (STING): It is the process of entering the bladder with a cystoscope and injecting filler into the mouth of the ureter. It is a daily short-term procedure and the success rate increases to 85% with repeated injections.
- Ureteral reimplantation surgery: It is the process of creating a tunnel at the lower end of the ureter and reattaching it to the bladder if necessary. There are many surgical techniques defined on this subject and their success rate is around 98%.
NOTE: The page content is for informational purposes only, please consult your doctor for diagnosis and treatment.
