Drogosis Achillefs Urological Surgeon Athens Greece

VESICOURETERAL REFLUX

Vesicoureteral Reflux

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Vesicoureteral reflux is the retrograde urine flow from the bladder to the ureter.

Normally, at the junction of the ureter with the bladder, there is a valvular mechanism preventing urine reflux.

In patients with vesicoureteral reflux this mechanism is deficient or absent.

Incidence

In the general population its frequency is around 1%.

In children with urinary tract infections it may affect 30-40%.

For this reason, children with urinary tract infection episodes should be checked for vesicoureteral reflux.

The condition may also develop in adults, but it is usually due to prostate hyperplasia, neurogenic bladder or as a result of a surgical procedure, which affects the function of the ureteral orifices.

Causes of vesicoureteral reflux

The causes may be congenital or acquired.

Congenital causes:

  • Anomalies in the development of the vesicoureteral reflux
  • Duplicated ureter
  • Ectopic ureter
  • Ureterocele

Acquired causes:

  • Chronic urinary retention due to prostate hypertrophy
  • Surgical procedures on the bladder, which affect the function of the ureteral orifices

Symptoms

Vesicoureteral reflux may be present but asymptomatic.

Nevertheless, it may manifest itself as a urinary tract infection (fever with shivering, frequent urination).

Vesicoureteral reflux may cause an inflammation called pyelonephritis.

Repeated episodes of pyelonephritis may result in permanent damage to the kidneys and cause renal failure.

Diagnosis

In recent years, due to the wide use of ultrasonography as part of prenatal screening, the possible existence of vesicoureteral reflux is also examined.

In other cases, the diagnosis is established after the investigation of the urinary tract due to urinary infection.

The following are needed for the diagnostic investigation of vesicoureteral reflux:

  • History and clinical examination
  • Urinalysis
  • Blood tests, including investigation of the renal function
  • Urinary tract ultrasound
  • Voiding cystourethrography

After the diagnostic investigation, the vesicoureteral reflux is classified into 5 grades according to its severity.

The appropriate treatment is determined according to this classification.

Treatment

In adults:

The treatment aims to eliminate the underlying cause of the reflux, which in most cases is prostate hypertrophy.

In children:

The treatment depends on the grade of severity and the child’s age.

In mild vesicoureteral reflux, chemoprophylaxis is preferred, i.e. long-term administration of small doses of antibiotics (6 months to 1 year).

In severe vesicoureteral reflux, which is accompanied by repeated episodes of urinary tract infections, the treatment is either endoscopic or open surgery.

The surgery aims to protect the renal function from future damage and resolve the problem definitively.