If a child has urinary tract infection, vesicoureteral reflux should be considered. After determination of vesicoureteral reflux, an approach according to age is taken.
What is Vesicoureteral Reflux (VUR)?
After the urine is made in the kidney, it comes to the urinary bladder through the ureter tubes. Here, after 400-500 cc, it is thrown out through urethra tubes.
The urine coming into the urinary bladder normally cannot go back to the kidneys because the lowest 2-3 cm of the ureter tubes are under the bladder membrane and due to the muscular structure in this area.
So there is a functional valve system. Vesicoureteral reflux is the urine in the bladder that travels backward from the ureter tubules towards the kidneys. In other words, it means urine leakage from the bladder to the kidney.
What Causes Vesicoureteral Reflux?
Vesicoureteral reflux occurs either due to congenital damage of the ureteral tubes at the entrance to the bladder or due to the increase in bladder pressure as a result of obstruction of the lower urinary tract due to congenital urethral valve.
In addition, in cases where bladder pressure is increased, such as a neurogenic bladder, it may develop due to congenital damage to the bladder muscles at the entrance to the bladder of the ureter tubes.
Why Is Vesicoureteral Reflux Important?
When the urine in the urinary bladder leaks to the kidney, that is, when vesicoureteral reflux, bacteria in the bladder pass to the kidney and causes kidney inflammation, which we call pyelonephritis.
This inflammation also disrupts the functional part of the kidney and causes kidney failure. Therefore, these patients should be followed very closely.
Vesicoureteral reflux can be seen in approximately 1-3% of newborns. While it is more common in boys in newborns, it is more common in girls over the age of 3.
32% of kidney failure in adults in our country is due to vesicoureteral reflux. It can be seen in 35-40% of children under 5 years of age who have had urinary tract infection.
Therefore, early diagnosis is very important.
How Is Vesicoureteral Reflux Diagnosed?
Voidin cystourethrography (VCUG) test is performed for diagnosis. In other words, imaging material is given to the bladder with a catheter and then a film is taken while peeing.
Then its degree is determined. Accordingly, it has 5 grades, 1 being the lightest 5 being the heaviest. Additionally, ultrasonography and scintigraphy may be required to evaluate the kidneys.
How Is Vesicoureteral Reflux Treatment?
If vesicoureteral reflux is detected in the newborn, antibiotic prophylaxis is taken and followed up until the age of 1 year.
Meanwhile, if infection occurs despite antibiotics and kidney functions deteriorate, surgical treatment may be required. Follow-up is done by VCUG, ultrasound and scintigraphy.
In the follow-up, if there is no infection and the kidneys are not damaged, they are followed up to the age of 3 and the last VCUG is evaluated. If it is grade 3 and above, it should be corrected surgically.
If the degree is 1-2, it is expected until the age of 5. If the degree is 1-2 and more than 5 years old, if there is no infection, treatment is not required in boys, but girls should be treated surgically.
There are 2 methods in surgery. In the first place, suburetric substance injection operation should be done. This method is the process of entering the bladder with a cystoscope and giving substance into the ureter mouth.
It is a daily procedure and its easy success is around 50-70%. If this vesicoureteral reflux treatment fails, the lower ureter tracts should be reattached to the bladder by creating a tunnel with open surgery. The success rate of this method is around 95%.