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Vesicoureteral Reflux

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Overview of Vesicoureteral Reflux

Vesicoureteral Reflux Meaning in Urdu

یہ بیماری زیادہ تر خواتین کو متاثر کرتی ہے۔ اس کی وجہ سے پیشاب مثانے سے بیضہ دانیوں یا گردوں تک وآپس جانے لگتا ہے۔ یہ بیماری پیشاب کی نالی کے انفیکشن کے خطرات کو بڑھا دیتے ہیں۔ اس کے علاوہ یہ بیماری گردوں کو نقصان بھی پہنچا سکتی ہے۔ بار بار پیشاب کرنے کی ضرورت، بخار، پیٹ کے ایک جانب درد، اور پیشاب کرتے وقت جلن کا احساس ایسی علامات ہیں جو اس بیماری کی وجہ سے لاحق ہو سکتی ہے۔ دو سال سے عمر کے بچوں (لڑکیوں) میں اس بیماری کے خطرات زیادہ ہوتے ہیں۔

Your urinary tract is like a one-way street that starts from the kidney and ends in the urethra. Vesicoureteral reflux is a health condition in which the urine goes in the wrong direction i.e. back to the ureters. 

The people most affected by vesicoureteral reflux are newborn babies, infants, and young children. But, vesicoureteral reflux is not a painful, incurable, or long-term disease. Vesicoureteral reflux can lead to urinary tract infections. 

Doctors usually grade vesicoureteral reflux from Grade 1 to 5. Grade 1 is the mildest form of VUR and Grade 5 is the most serious one. Vesicoureteral reflux can cause UTI and even kidney damage in rare cases. 

Prevalence

About 1 out of 3 children who suffer from fever and UTI together have a vesicoureteral reflux health condition. The number of children suffering from vesicoureteral may even be higher as the symptoms of VUR may not be apparent.

Signs and Symptoms of Vesicoureteral Reflux

Most children do not show any vesicoureteral reflux symptoms. However, when they tend to show any symptoms, it is mostly a urinary tract infection (UTI) that is caused by bacteria. UTIs may not necessarily come up with any symptoms, however, when they do, they may include:

If you notice these above symptoms of UTI in your children, you need to visit a doctor as soon as possible. 

Other vesicoureteral symptoms may also include

 

Types of Vesicoureteral Reflux

Vesicoureteral reflux can be divided into two types i.e. primary and secondary.

  1. Primary Vesicoureteral Reflux 

It is the most common type of vesicoureteral reflux. Children suffering from primary vesicoureteral reflux are born with a defect in the valve that normally prevents the urine from flowing back from the bladder into the ureter. 

The ureters straighten and lengthen as the child grows. It helps improve the valve's function and correct the reflux as well. 

  1. Secondary Vesicoureteral Reflux 

Secondary VUR occurs when a blockage in the urinary tract causes increased pressure and then pushes the urine back up from the urethra into your child’s ureters, bladder, and even kidneys.

This blockage can be due to abnormal folds of the tissues in the urethra that affect the urine from freely coming or flowing out of the bladder of your child. Another reason for blockage can be the nerves that are unable to stimulate the release of urine. Children who suffer from secondary VUR can often have bilateral reflux.

Causes of Vesicoureteral Reflux

There is a flap at the joining of the ureter and bladder. Normally the valve allows only a one-way flow of urine from the ureter to the bladder. However, when the flap does not work, it can lead the urine to backflow. This can affect both of your ureters. This condition is what we call “primary vesicoureteral reflux”. While in case of the secondary vesicoureteral reflux, the blockage is at the bladder that causes the urine to push back. 

Most children are born with primary vesicoureteral reflux, which means that they are born with an abnormal ureter. Primary VUR gets better or can simply go away when the child grows older. 

Cause of VUR in Adults

In adults, the causes of vesicoureteral reflux can be due to neurogenic bladder, benign prostate hypertrophy, or they had surgery in the regions of the body that are near the ureters. 

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Risk Factors of Vesicoureteral Reflux

Here are some factors that can increase the risk of suffering from vesicoureteral reflux:

  • Bladder and Bowel Dysfunction (BBD) - Children who suffer from BBD, hold their stool and urine for longer periods of time. It can lead to recurrent urinary tract infections (UTIs), which can lead to vesicoureteral reflux. 
  • Gender - Normally girls have higher chances of suffering from VUR as compared to boys. However, there is an exception, in the case of VUR at birth, which is more common in boys. 
  • Race - White children are more prone to suffer from vesicoureteral reflux. 
  • Age - Infants and children of age upto 2 years are more likely to suffer from VUR as compared to older children. 
  • Family History - Primary vesicoureteral also tends to run in family. So, children, whose parents had this health issue, are at higher risk of suffering from VUR. Siblings of children who have this condition are also at higher risk, therefore, your doctor may also recommend screening for the siblings of a kid with primary VUR. 

Health Complications due to Vesicoureteral Reflux 

The primary health concern with vesicoureteral reflux is kidney damage. More severe the VUR, the more serious health complications a  person is likely to suffer. 

Some of the health complications due to VUR are:

  • High Blood Pressure - The kidney is responsible for removing the waste from your bloodstream. If kidneys are damaged, the resultant buildup of waste can lead to high bp. 
  • Kidney or Renal Scarring - If the UTI is untreated, it can cause scarring which is permanent damage to the tissues of the kidney. If the scarring is extensive, it can cause kidney failure and high blood pressure. 
  • Kidney Failure - The kidney filter system is highly affected due to scarring. This can cause kidney failure, which can occur quickly such as in the case of acute kidney failure or it may develop over time in the case of chronic kidney disease. 
  • Other health complications include kidney infections, kidney damage (nephrotic syndrome), constipation, bedwetting, urinary retention, and other long-term complications. 

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Prevention

There is no known way to prevent vesicoureteral reflux (VUR) either with food or with medication or lifestyle changes. However, there are a few steps that you can opt for to improve the urinary health of your child.

You can do this by making sure that your child

  • Urinate regularly
  • Gets his or her diaper changed immediately when soiled
  • Drink enough water
  • Gets treated for fecal or urinary inconsistence and constipation as soon as possible. 

You need to help your child and make sure that he/she is healthy in every way. Make a healthy, balanced diet plan and encourage exercise.

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Diagnosis

A pediatric urologist or urologist can ask about your child’s symptoms, health condition, medical history, or if the child has UTI. 

The most common type of imaging tests used to diagnose vesicoureteral reflux (VUR) are:

  • VCUG - Voiding cystourethrogram or VCUG is an X-ray image of the bladder and urethra taken during, before, and after urination. It is called voiding. A small catheter is placed in the urethra and it is then used to fill the bladder of your child with a special dye that can be seen with the help of an X-ray. Anesthesia may not be necessary but in some children, sedation is given.
  • RNC- Radionuclide cystogram is a type of nuclear scan. In this, radioactive material is placed in your child’s bladder. The radioactive material in the child is detected with the help of a scanner when the bladder is empty or when a child urinates. Anesthesia may not be necessary but in some children, sedation is given. RNC is more sensitive as compared to the VCUC, however, it does not provide any exact detail for the anatomy of the bladder.
  • DMSA Scan - The dimercaptosuccinic acid (DMSA) scan is needed to check if the kidney of your child has developed any scar due to UTIs. This scan is recommended after the kidney ultrasound came abnormal. 
  • Ultrasound - It is a safe and painless imaging technique. In the ultrasound, the image of the entire urinary tract of the child is obtained. 

An ultrasound test is normally done on:

  • Infants when are diagnosed with urine blockage during pregnancy. 
  • Children under 5 years and above of age suffering from UTIs.
  • Children suffering from both fever and UTIs are called febrile UTIs irrespective of age. 
  • Men who are not active sexually and suffering from UTIs irrespective of age.
  • Children having a family history of VUR or a sibling affected by VUR.

Other Vesicoureteral Reflux Diagnostic Tests

If a child has been diagnosed with vesicoureteral reflux or VUR, the following other diagnostic tests are recommended as well:

  • Blood Tests - Various blood tests are done to check the protein or creatinine levels in the blood as these indicate signs of kidney damage.
  • Blood Pressure Check - Children are at higher risk of suffering from high blood pressure due to kidney problems. Hence, the blood pressure of the children is checked. 
  • Urine Tests and Culture - Urinalysis and urine culture tests are done to check the signs of infection in the urine that are damaging to the kidney. 

Grading of the VUR

After the diagnosis, the doctor would grade the VUR from I to V (from least severe to extremely severe).

Treatment of Vesicoureteral Reflux | When to Consult a Doctor

The vesicoureteral reflux treatment is based on the severity of the health condition. In primary vesicoureteral reflux, the children normally get better with age, therefore the doctor would recommend a wait-and-see approach. 

For severe cases, the following treatment options are recommended:

  1. Medication

Antibiotics are the first line of treatment and a prompt one as well in case of UTIs to keep the infection away from the kidneys. To prevent UTIs further, the doctor would recommend, antibiotics of lower doses. 

A child who is taking medication for the UTI needs to be monitored till they are taking medicine. This monitoring includes physical examination and urine tests to detect infections. Apart from this, the scans are done to check if the vesicoureteral reflux has outgrown.

  1. Surgery 

In surgical treatment, the valve between the ureter and bladder is repaired. The defect in the valve keeps it closing and prevents the urine from flowing backward. 

The following surgical methods are used to repair the valve:

  • Open Surgery - In this surgery, an incision in the lower abdomen is made, and from which a surgeon repairs the defective flap. This surgery is performed using general anesthesia. In this surgery, a child needs to stay in the hospital as the catheter is placed to drain the urine. 

  • Robotic-Assisted Laparoscopic Surgery - This surgery is similar to open surgery but it involves small incisions. The advantage of small incisions is that it leads to fewer bladder spasms as compared to open surgery.

  • Endoscopic Surgery - In endoscopic surgery, the doctor inserts a lighted tube or cystoscope through the urethra to check the insides of the bladder of your child. A bulking agent is then injected around the opening of the affected ureter to try to improve the strengthening ability to close properly. Compared to open surgery, this method has lower risks due to few risks. But, it may not be much effective. This procedure also requires anesthesia.

Treatment of vesicoureteral reflux varies from patient to patient and hence a personalised treatment plan is prepared for each patient. The reason is that cause of VUR is not the same in all patients so a patient's medical history and symptoms are checked. 

In case of any queries and concerns, you need to reach out to a certified urologist to get consultation and customised treatment.

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