Vesicoureteral reflux

In order to better understand vesicoureteral reflux, we will say a few words about the normal structure and function of the urinary tract.

Urinary tract

Kidneys clean and filter the blood to produce urine. Urine is a liquid waste. It travels from the kidneys through the ureters into the bladder. The bladder retains urine. It acts as a storage container. As the bladder fills, the muscle relaxes in order to enable the bladder to contain more urine. The control muscle (sphincter) remains firm to prevent urine leakage.

Inside the bladder, a valve mechanism prevents urine from returning to the ureters. When the bladder fills up, it sends a message to the brain. The brain decides when to start releasing urine. The bladder contracts as the control muscle relaxes. This allows the bladder to expel all the urine.

Reflux

What is VUR? Vesicoureteral reflux (VUR) is a condition in which urine can flow from the bladder back to the ureter and kidney. This is caused by a problem with the valve mechanism.

The pressure of urine filling the bladder should close the ureter. It must not allow urine to flow back into the ureter. When the ureter connects to the bladder at an unusual angle, reflux can occur. This can also happen when the length of the ureter that passes through the bladder wall is too short.

VUR becomes a problem when urine in the bladder becomes infected. Infected urine travels back to the kidneys. This can cause a kidney infection. Kidney infections cause damage.

How is VUR diagnosed?

VUR may be suspected if the ultrasound shows an enlargement of the ureter or renal pelvis. In order to diagnose VUR, the so-called urinary cystourethrography or MCUG in necessary. This is an X-ray scan of the urinary tract using a special color (contrast). If VUR is present, this test also shows its degree. There are five degrees of VUR.

Recently, VUR can also be diagnosed by contrast ultrasound cystography. A device is inserted into the bladder, which is visualized on a special ultrasound device. This method can determine the degree of VUR.

How VUR is treated and monitored...

...depends on the degree of the reflux itself, as well as the general condition of the child, their orderly growth and development.

It is possible to monitor VUR by introducing uroprophylaxis (antibiotics can be used to prevent infections until VUR recedes on its own).

Endoscopically - "the gold standard" in VUR treatment, performed by injecting endo paste at the place where the ureter enters the bladder. Children usually go home the same day.

Finally, surgically - the so-called ureteral re-implantation, which aims to correct ureteral defects and stop VUR.

MD Irena Maric

The author of this text is a specialist in pediatric surgery and a subspecialist in urology. She obtained her professional degrees in prominent regional and international institutions. Her career dedicated to treating children at the highest level of quality was built in children's clinics throughout the region, Europe and the USA, including the Clinical Center of Montenegro, Great Ormond Street Hospital in London and the Anderson Center of Excellence in Cincinnati, USA.