About Vesicoureteric Reflux


	Phimosis

	Inguinal Hernia

	Umbilical Hernia

	Hydrocoele

	Undescended Testicle

	Tongue-Tie

	Pyloric Stenosis

	Painful Scrotum

	Vesicoureteric Reflux

	Hypospadias

	Pelvi-ureteric Junction (PUJ) Obstruction

	Intussusception

	Hirschsprung's Disease

	Circumcision

	Inguinal Hernia Repair

	Repair of Hydrocoele

	Orchidopexy

Urinary tract abnormalities are discovered in about 50% of children who suffer from an urinary tract infection (UTI). It is important, therefore, to investigate the urinary tract of all children who have a documented UTI. The most common abnormality is vesicoureteric reflux (VUR) which is a condition in which there is reflux of urine from the bladder upwards into the ureter and often into the kidney. VUR may be caused by an abnormally short length of the ureter within the muscular bladder wall. It may also be caused by an abnormality of the opening of the ureter into the bladder. In some cases, VUR may occur as a result of some other abnormality of the bladder. There are 5 grades of VUR, ranging from grade 1 which is mild, to grade 5 in which there is severe reflux with damage to the kidney.

VUR usually presents within the first year or two of life and is more common in girls than boys. If an UTI occurs in a boy, it is even more likely that there is an urinary tract abnormality, such as VUR.

In 10-20% of children with UTI that is due to VUR, damage to the kidney has already occurred. The main aim of treatment of VUR is to prevent any further damage to the kidney.

The 3 main investigations that are useful in children who have urinary tract infections, and in those children who are found to have VUR are:

Kidney and bladder ultrasound
Contrast study of the bladder (micturating cysto-urethrogram)
Nuclear scan of the kidney (DMSA scan/MAG3 Scan) to assess scarring and function of kidneys

The micturating cysto-urethrogram (MCU) should only be performed by an experienced Radiologist and in those children who will not become overly distressed and who will co-operate with the procedure. Antibiotics should be given at the time of the MCU and may be continued for 2-3 days afterwards.

In 80% of children with mild/moderate VUR, the reflux will resolve gradually over 4-5 years. The more severe grades of VUR have only 30-40% chance of resolving spontaneously and because of this are more likely to require an operation.

Antibiotics that prevent further infections will be prescribed by the Paediatrician or Paediatric Surgeon and should be taken once a day, until either the VUR has resolved, or until the child is 5 years of age. If there is associated constipation, this may increase the number of breakthrough UTIs, which occur probably as a result of incomplete bladder emptying.

The indications for an operation to correct the VUR include: breakthrough UTIs, deteriorating kidney function, older age at presentation, further infections after antibiotics have stopped at 5 years of age and more severe reflux affecting both sides.

About 20% of those children who have kidney scarring demonstrated on the nuclear scan develop hypertension in later life. It is important, therefore, to check the blood pressure in these children throughout life.

As VUR often runs in the family, and indeed in up to 30% of sisters, it is important to screen siblings, especially sisters and especially those under 2 years of age for VUR. This usually involves a kidney and bladder ultrasound, but if an abnormality is detected, an MCU may need to be performed.

The operation to correct VUR involves re-implanting the refluxing ureter under the lining of the bladder to another site within the bladder. This is successful in about 98% of children and requires up to a week in hospital.

Another technique, known as the STING which may be performed as a daycase, involves the injection of synthetic material around the opening of the ureter into the bladder and has a success rate of about 80% in experienced hands.

Site by Asymmetric Media