Vesicoureteral reflux

Question 1

What is the definition of Vesicoureteral reflux?

Answer 1

Vesicoureteral reflux (VUR) is a condition characterized by the abnormal backward flow of urine from the bladder back into the ureters and sometimes up into the kidneys.

Question 2

Causes of Vesicoureteral reflux

Answer 2

VUR is commonly seen in infants and young children. It occurs when the valve-like mechanism that normally prevents urine from flowing backward (refluxing) from the bladder into the ureters is faulty or underdeveloped. This can be due to a congenital abnormality, where the valve mechanism doesn’t function properly, or it may be caused by a structural abnormality of the ureters or bladder.

Question 3

Symptoms of Vesicoureteral reflux

Answer 3

Frequent urinary tract infections: Children with VUR are more prone to UTIs, which can manifest as fever, pain or discomfort during urination, increased urinary frequency, urgency, and sometimes abdominal or back pain.

Kidney infections: VUR increases the risk of kidney infections (pyelonephritis). Signs and symptoms of kidney infection may include high fever, chills, flank pain (pain in the side or back), nausea, vomiting, and general malaise.

Poor growth or failure to thrive: In severe cases of VUR, where the kidneys are significantly affected by recurrent infections, it may lead to impaired kidney function and poor growth.

Question 4

Diagnosis of Vesicoureteral reflux

Answer 4

Voiding cystourethrogram (VCUG): This is the gold standard test for diagnosing VUR. It involves filling the bladder with a contrast agent and observing the flow of urine during voiding using X-ray or fluoroscopy.

Renal ultrasound: This imaging test is used to assess the structure and function of the kidneys and may reveal abnormalities that could suggest VUR.

Urine tests: Urinalysis and urine culture may be performed to detect signs of infection and assess the presence of bacteria or white blood cells in the urine.

Question 5

Treatment of Vesicoureteral reflux

Answer 5

Observation: In mild cases of VUR without UTIs or kidney involvement, regular monitoring may be recommended, as the condition may resolve on its own over time.

Antibiotic prophylaxis: This involves taking low-dose antibiotics on a daily basis to prevent UTIs and reduce the risk of kidney infections.

Surgical intervention: In some cases, particularly when VUR is severe or persistent, surgical correction may be considered. Surgical options may include ureteral reimplantation (repositioning the ureters to correct reflux) or endoscopic injection of a bulking agent around the ureterovesical junction to create a valve-like mechanism.

Question 6

Complications of Vesicoureteral reflux

Answer 6

If left untreated or poorly managed, VUR can lead to recurrent kidney infections, kidney damage, scarring (renal parenchymal scarring), and long-term complications affecting kidney function.
Monitoring and appropriate management of VUR aim to prevent these complications and preserve kidney health.

Question 7

What is Prune Belly syndrome?

Answer 7

-Hereditary disease (AR)

-Clinical Presentation: Prune Belly syndrome typically presents with the following features:

Absent or severely weak abdominal muscles, leading to a protruding, wrinkled abdomen.
Urinary tract abnormalities, such as dilated ureters, hydronephrosis (enlargement of the kidneys due to urine backup), and bladder dysfunction.
Undescended testicles in males (cryptorchidism).

-Diagnosis:
US and Voiding Cystourethrogram