vesicoureteral reflux, VUR

Normally, the tubes that carry urine from the kidneys to the bladder (ureters) pump it into the bladder and do not allow significant amounts of urine to flow backward from the bladder toward the kidneys. Vesicoureteral reflux (VUR) occurs when urine leaks from the bladder into the ureters again. More than a small amount of backflow (reflux) over time can lead to recurrent urinary tract infections.

VUR is usually detected when a child, almost always a girl, has repeated urinary tract infections. Imaging studies of the bladder and ureters show enlargement of the diameter (dilation) of the ureters. Isotope studies may be used to demonstrate the backflow of urine into the ureters.

VUR is generally speaking a disease of young girls. Over time, the reflux tends to diminish and the dilation of the ureters diminishes to more or less normal. However, kidney damage (scarring) from repeated infections is a major worry with urinary reflux. Various approaches are used to treat ureteral reflux, including daily preventative antibiotics, surgery to "reimplant" the ureters, and the newest procedure known as "Deflux." In this procedure, a substance is injected into the tissue around the mouth of the ureter, which stops the reflux for at least several years in over 90% of the cases. This procedure has the great advantage of being done through a cystoscope, meaning that an abdominal incision is avoided.

VUR is often a familial disease, and siblings of VUR patients are frequently screened with imaging studies even if they have no symptoms of recurrent UTI. This is because "silent" unsuspected infections can over time lead to severe kidney damage, dialysis, and eventually kidney transplant.

There are various philosophies about the management of VUR. The natural history of VUR is that over a period of years it tends to improve on its own - it is "outgrown." Therefore, management by whatever method chosen is not a life-long problem, and if successful will result in a healthy child with no long-term damage to the kidneys.

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