430:
and parents should focus on bowel and bladder management. Children who hold their bladder or who are constipated have a greater number of infections than children who void on a regular schedule. When medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive renal scarring then surgical interventions may be necessary. Medical management is recommended in children with Grade I-III VUR as most cases will resolve spontaneously. A trial of medical treatment is indicated in patients with Grade IV VUR especially in younger patients or those with unilateral disease. Of the patients with Grade V VUR only infants are trialled on a medical approach before surgery is indicated, in older patients surgery is the only option.
134:
158:
198:. Urine normally travels in one direction (forward, or anterograde) from the kidneys to the bladder via the ureters, with a one-way valve at the vesicoureteral (ureteral-bladder) junction preventing backflow. The valve is formed by oblique tunneling of the distal ureter through the wall of the bladder, creating a short length of ureter (1β2 cm) that can be compressed as the bladder fills. Reflux occurs if the ureter enters the bladder without sufficient tunneling, i.e., too "end-on".
316:
25:
533:
A surgical approach is necessary in cases where a breakthrough infection results despite prophylaxis, or there is non-compliance with the prophylaxis. Similarly if the VUR is severe (Grade IV & V), there are pyelonephritic changes or congenital abnormalities. Other reasons necessitating surgical
379:
DMSA scintigraphy is used for the evaluation of the parenchymal damage, which is seen as cortical scars. After the first febrile UTI, the diagnostic role of an initial scintigraphy for detecting the damage before the VCUG was investigated and it was suggested that VCUG can be omitted in children who
537:
There are four types of surgical procedure available for the treatment of VUR: endoscopic (STING/HIT procedures); laparoscopic; robotic-assisted laparoscopic; and open procedures (Cohen procedure, Leadbetter-Politano procedure, Lich-Gregoir technique). Laparoscopic and robotic-assisted laparoscopic
261:
obliquely and run submucosally for some distance. This, in addition to the ureter's muscular attachments, helps secure and support them posteriorly. Together these features produce a valvelike effect that occludes the ureteric opening during storage and voiding of urine. In people with VUR, failure
429:
The goal of treatment is to minimize infections, as it is infections that cause renal scarring and not the vesicoureteral reflux. Minimizing infections is primarily done by prophylactic antibiotics in newborns and infants who are not potty trained. However, in children who are older, physicians
420:
The younger the patient and the lower the grade at presentation the higher the chance of spontaneous resolution. Approximately 85% of grade I & II VUR cases will resolve spontaneously. Approximately 50% of grade III cases and a lower percentage of higher grades will also resolve spontaneously.
283:
In this category the ureters' valvular mechanism is initially intact and healthy but becomes overwhelmed by increased bladder pressures associated with obstruction, which distorts the ureterovesicular junction. The obstructions may be anatomical or functional. Secondary VUR can be further divided
375:
VCUG is the method of choice for grading and initial workup, while RNC is preferred for subsequent evaluations as there is less exposure to radiation. A high index of suspicion should be attached to any case where a child presents with a urinary tract infection, and anatomical causes should be
360:
An abdominal ultrasound might suggest the presence of VUR if ureteral dilatation is present; however, in many circumstances of VUR of low to moderate, even high severity, the sonogram may be completely normal, thus providing insufficient utility as a single diagnostic test in the evaluation of
559:
The prevalence of VUR is difficult to ascertain at any one time, it differs depending on the population looked at. The prevalence of VUR in healthy children has been estimated 0.4-1.8% However in children with UTI the prevalence is up to 30%. Probably the prevalence in healthy population is
520:
Urine cultures are performed 3 monthly to exclude breakthrough infection. Annual radiological investigations are likewise indicated. Good perineal hygiene, and timed and double voiding are also important aspects of medical treatment. Bladder dysfunction is treated with the administration of
560:
significantly higher than the traditional estimates, up to 10% of the population. Younger children are more prone to VUR because of the relative shortness of the submucosal ureters. This susceptibility decreases with age as the length of the ureters increases as the children grow.
270:
Insufficient submucosal length of the ureter relative to its diameter causes inadequacy of the valvular mechanism. This is precipitated by a congenital defect or lack of longitudinal muscle of the portion of the ureter within the bladder resulting in an
550:
recommends ongoing monitoring of children with VUR until the abnormality resolves or is no longer clinically significant. The recommendations are for annual evaluation of blood pressure, height, weight, analysis of the urine, and kidney ultrasound.
383:
Early diagnosis in children is crucial as studies have shown that the children with VUR who present with a UTI and associated acute pyelonephritis are more likely to develop permanent renal cortical scarring than those children without VUR, with an
459:. Both constituents are well known from previous uses in medicine. They are also biocompatible, which means that they do not cause significant reactions within the body. In fact, hyaluronic acid is produced and found naturally within the body.
467:
Medical treatment entails low dose antibiotic prophylaxis until resolution of VUR occurs. Antibiotics are administered nightly at half the normal therapeutic dose. The specific antibiotics used differ with the age of the patient and include:
1180:
1165:
874:
Peters CA, Skoog SJ, Arant BS, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgrass WT, Diaz M (September 2010). "Summary of the AUA Guideline on
Management of Primary Vesicoureteral Reflux in Children".
827:
Sheu, Ji-Nan; Wu, Kang-Hsi; Chen, Shan-Ming; Tsai, Jeng-Dau; Chao, Yu-Hua; Lue, Ko-Huang (2013). "Acute 99mTc DMSA Scan
Predicts Dilating Vesicoureteral Reflux in Young Children With a First Febrile Urinary Tract Infection".
648:
Miyakita, Hideshi; Hayashi, Yutaro; Mitsui, Takahiko; Okawada, Manabu; Kinoshita, Yoshiaki; Kimata, Takahisa; Koikawa, Yasuhiro; Sakai, Kiyohide; Satoh, Hiroyuki; Tokunaga, Masatoshi; Naitoh, Yasuyuki (2020-04-01).
438:
Endoscopic injection involves applying a gel around the ureteral opening to create a valve function and stop urine from flowing back up the ureter. The gel consists of two types of sugar-based molecules called
969:
TekgΓΌl, S; Riedmiller, H; Hoebeke, P; KoΔvara, R; Nijman, RJ; Radmayr, C; Stein, R; Dogan, HS; European
Association of, Urology (September 2012). "EAU guidelines on vesicoureteral reflux in children".
563:
Four times as many girls as boys are diagnosed with VUR during childhood. Boys most commonly present during their first year, and girls present more cumulatively throughout childhood.
1302:
1004:
Akhavan, Ardavan; Avery, Daniel; Lendvay, Thomas S. (2014). "Robot-assisted extravesical ureteral reimplantation: Outcomes and conclusions from 78 ureters".
721:
Wongbencharat, Kunruedi; Tongpenyai, Yothi; Na-rungsri, Kunyalak (2016-03-01). "Renal ultrasound and DMSA screening for high-grade vesicoureteral reflux".
307:
Resolution of functional VUR will usually occur if the precipitating cause is treated and resolved. Medical and/or surgical treatment may be indicated.
214:
while in utero as well as when a sibling has VUR (though routine testing in either circumstance is controversial). Reflux also increases risk of acute
42:
1464:
1095:
1295:
1195:
206:
Most children with vesicoureteral reflux are asymptomatic. Vesicoureteral reflux may be diagnosed as a result of further evaluation of
1549:
141:
Ultrasound image showing abnormal vesicoureteral junction and dilated distal ureter resulting in primary vesicoureteral reflux (VUR).
108:
89:
61:
547:
1388:
1288:
68:
46:
538:
procedures are often imitation of classical open procedures in laparoscopic or robotic-assisted laparoscopic environments.
534:
intervention are failure of renal growth, formation of new scars, renal deterioration and VUR in girls approaching puberty.
304:
and non-neurogenic bladder. Bladder infections may cause reflux due to the elevated pressures associated with inflammation.
1393:
482:
388:
of 2.8. Thus VUR not only increases the frequency of UTIs, but also the risk of damage to upper urinary structures and
75:
708:
772:
Zhang, Xin; Xu, Hong; Zhou, Lijun; Cao, Qi; Shen, Qian; Sun, Li; Fang, Xiaoyan; Guo, Wei; Zhai, Yihui (2014-01-01).
410:
Grade III β mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices
57:
35:
1426:
416:
Grade V β gross dilatation of the ureter, pelvis and calyces; ureteral tortuosity; loss of papillary impressions
1479:
1398:
1206:
1111:
Nahon, I; Waddington, G; Dorey, G; Adams, R (2011). "The history of urologic surgery: from reeds to robotics".
335:
1474:
1361:
1353:
369:
350:
226:
292:
Posterior urethral valves; urethral or meatal stenosis. These causes are treated surgically when possible.
133:
389:
1526:
1366:
1511:
1469:
1381:
272:
237:, with poor appetite and sometimes foul-smelling urine, while older children typically present with
157:
1516:
1184:
599:
Williams, Gabrielle; Fletcher, Jeffery T.; Alexander, Stephen I.; Craig, Jonathan C. (2008-05-01).
82:
1521:
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853:
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301:
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1021:
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499:
493:
365:
347:
219:
207:
1189:
1543:
1489:
1312:
1072:
576:
514:
413:
Grade IV β dilation of the renal pelvis and calyces with moderate ureteral tortuosity
1124:
857:
813:
758:
1506:
1494:
1484:
1268:
509:
354:
332:
222:, so testing for reflux may be performed after a child has one or more infections.
1211:
1017:
982:
841:
1499:
1333:
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600:
472:
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327:
211:
191:
24:
1222:
888:
1421:
1376:
1338:
1328:
1174:
579:
and noted that there were specific mechanisms to prevent the reflux of urine.
476:
448:
385:
342:
262:
of this mechanism occurs, with resultant backward (retrograde) flow of urine.
937:
797:
742:
676:
626:
376:
excluded. A VCUG and abdominal ultrasound should be performed in these cases
1263:
1228:
1132:
1064:
1025:
990:
955:
896:
849:
805:
789:
750:
694:
634:
617:
319:
VCUG demonstrating bilateral Grade II (non-dilating) vesicoureteral reflux.
1056:
928:
651:"Guidelines for the medical management of pediatric vesicoureteral reflux"
362:
242:
234:
215:
1157:
1040:
912:"Vesicoureteral Reflux, Reflux Nephropathy, and End-Stage Renal Disease"
774:"Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI"
1413:
504:
238:
230:
151:
734:
667:
407:
Grade II β reflux into the renal pelvis and calyces without dilatation
1320:
1169:
254:
195:
187:
16:
Backwards flow of urine from the bladder into the ureters and kidneys
572:
314:
179:
1233:
1200:
361:
children suspected of having VUR, such as those presenting with
1284:
18:
571:
As early as the time of Graeco-Roman physician and anatomist
400:
Vesicoureteral reflux (VUR) is graded according to severity.
1041:"What is the normal prevalence of vesicoureteral reflux?"
489:
After 2 months the following antibiotics are suitable:
323:
The following procedures may be used to diagnose VUR:
1147:
380:
has no cortical scars and urinary tract dilatation.
1457:
1412:
1352:
1319:
1243:
1151:
1086:Rink, Richard C.; Mouriquand, Pierre D. E. (2010).
707:Institute of Urology & Nephrology, London, UK,
145:
126:
49:. Unsourced material may be challenged and removed.
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605:Journal of the American Society of Nephrology
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132:
123:
945:
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709:The cellular basis of bladder instability
684:
666:
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109:Learn how and when to remove this message
404:Grade I β reflux into non-dilated ureter
225:In infants, the signs and symptoms of a
182:flows retrograde, or backward, from the
588:
284:into anatomical and functional groups.
485:(co-trimoxazole) β 6 weeks to 2 months
212:ureters draining urine from the kidney
1465:Urologic chronic pelvic pain syndrome
7:
594:
592:
47:adding citations to reliable sources
14:
239:discomfort or pain with urination
655:International Journal of Urology
23:
1125:10.7257/1053-816X.2011.31.3.173
548:American Urological Association
34:needs additional citations for
1389:Neurogenic bladder dysfunction
711:UJUS 2009, Retrieved 4-20-2010
479:β infants younger than 6 weeks
1:
1394:Bladder sphincter dyssynergia
1039:Sargent, M. A. (2000-08-01).
910:Brakeman, Paul (2008-07-21).
483:Trimethoprim-sulfamethoxazole
451:for this combination include
1018:10.1016/j.jpurol.2014.01.028
1006:Journal of Pediatric Urology
983:10.1016/j.eururo.2012.05.059
842:10.1097/rlu.0b013e318279f112
253:In healthy individuals the
1566:
889:10.1016/j.juro.2010.05.065
1550:Urinary bladder disorders
1427:Non-gonococcal urethritis
830:Clinical Nuclear Medicine
273:ureterovesicular junction
140:
131:
1480:Retroperitoneal fibrosis
1399:Vesicointestinal fistula
723:Pediatrics International
336:voiding cystourethrogram
178:is a condition in which
1475:Urinary tract infection
601:"Vesicoureteral Reflux"
390:end-stage renal disease
370:urinary tract infection
351:Dimercaptosuccunic Acid
227:urinary tract infection
58:"Vesicoureteral reflux"
877:The Journal of Urology
790:10.1542/peds.2012-2650
618:10.1681/ASN.2007020245
496:{5β7 mg/kg/24hrs}
320:
208:dilation of the kidney
176:vesicoureteric reflux,
1404:Vesicoureteral reflux
1367:Interstitial cystitis
1090:. Saunders/Elsevier.
1057:10.1007/s002470000263
318:
300:Bladder instability,
168:Vesicoureteral reflux
127:Vesicoureteral reflux
1512:Urinary incontinence
1470:Obstructive uropathy
1382:Hemorrhagic cystitis
434:Endoscopic injection
43:improve this article
1045:Pediatric Radiology
929:10.1155/2008/508949
916:Advances in Urology
529:Surgical management
275:(UVJ) abnormality.
1439:Urethral stricture
1344:Ureteric stricture
1244:External resources
321:
302:neurogenic bladder
243:frequent urination
202:Signs and symptoms
1537:
1536:
1449:Urethral caruncle
1434:Urethral syndrome
1278:
1277:
1097:978-1-4160-3204-5
1088:Pediatric Urology
735:10.1111/ped.12803
668:10.1111/iju.14223
463:Medical treatment
229:may include only
220:kidney infections
186:into one or both
174:), also known as
165:
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121:Medical condition
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118:
111:
93:
1557:
1311:Diseases of the
1305:
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1282:
1149:
1137:
1136:
1113:Urologic Nursing
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1083:
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1001:
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971:European Urology
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712:
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645:
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596:
523:anticholinergics
190:and then to the
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124:
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107:
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92:
51:
27:
19:
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1564:
1560:
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1558:
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1555:
1554:
1540:
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1538:
1533:
1453:
1444:Meatal stenosis
1408:
1348:
1315:
1309:
1279:
1274:
1273:
1239:
1238:
1160:
1146:
1141:
1140:
1110:
1109:
1105:
1098:
1085:
1084:
1080:
1038:
1037:
1033:
1003:
1002:
998:
968:
967:
963:
909:
908:
904:
873:
872:
865:
826:
825:
821:
771:
770:
766:
720:
719:
715:
706:
702:
647:
646:
642:
598:
597:
590:
585:
569:
557:
544:
531:
465:
445:hyaluronic acid
436:
427:
398:
313:
298:
290:
281:
268:
259:urinary bladder
251:
204:
155:
122:
115:
104:
98:
95:
52:
50:
40:
28:
17:
12:
11:
5:
1563:
1561:
1553:
1552:
1542:
1541:
1535:
1534:
1532:
1531:
1530:
1529:
1524:
1519:
1509:
1504:
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1502:
1497:
1492:
1482:
1477:
1472:
1467:
1461:
1459:
1455:
1454:
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1451:
1446:
1441:
1436:
1431:
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1429:
1418:
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1410:
1409:
1407:
1406:
1401:
1396:
1391:
1386:
1385:
1384:
1379:
1374:
1372:Hunner's ulcer
1369:
1358:
1356:
1350:
1349:
1347:
1346:
1341:
1336:
1331:
1325:
1323:
1317:
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1310:
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1300:
1293:
1285:
1276:
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1272:
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1260:
1248:
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1240:
1237:
1236:
1225:
1214:
1203:
1192:
1177:
1161:
1156:
1155:
1153:
1152:Classification
1145:
1144:External links
1142:
1139:
1138:
1103:
1096:
1078:
1051:(9): 587β593.
1031:
1012:(5): 864β868.
996:
961:
902:
883:(3): 1134β44.
863:
836:(3): 163β168.
819:
784:(1): e30βe38.
764:
729:(3): 214β218.
713:
700:
661:(6): 480β490.
640:
611:(5): 847β862.
587:
586:
584:
581:
575:described the
568:
565:
556:
553:
543:
540:
530:
527:
518:
517:
515:Cephalosporins
512:
507:
502:
500:Nalidixic acid
497:
494:Nitrofurantoin
487:
486:
480:
464:
461:
435:
432:
426:
423:
418:
417:
414:
411:
408:
405:
397:
394:
366:hydronephrosis
358:
357:
348:Technetium-99m
345:
339:
330:
312:
309:
297:
294:
289:
286:
280:
277:
267:
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250:
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203:
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31:
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22:
15:
13:
10:
9:
6:
4:
3:
2:
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1515:
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1510:
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1505:
1501:
1498:
1496:
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1490:Bladder stone
1488:
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1486:
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1481:
1478:
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1473:
1471:
1468:
1466:
1463:
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1432:
1428:
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1411:
1405:
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1400:
1397:
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1387:
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1378:
1375:
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1370:
1368:
1365:
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1313:urinary tract
1306:
1301:
1299:
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1287:
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1283:
1270:
1266:
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1167:
1163:
1162:
1159:
1154:
1150:
1143:
1134:
1130:
1126:
1122:
1119:(3): 173β80.
1118:
1114:
1107:
1104:
1099:
1093:
1089:
1082:
1079:
1074:
1070:
1066:
1062:
1058:
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1046:
1042:
1035:
1032:
1027:
1023:
1019:
1015:
1011:
1007:
1000:
997:
992:
988:
984:
980:
977:(3): 534β42.
976:
972:
965:
962:
957:
953:
948:
943:
939:
935:
930:
925:
921:
917:
913:
906:
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886:
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577:urinary tract
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1507:Malakoplakia
1495:Kidney stone
1485:Urolithiasis
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41:Please help
36:verification
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1500:Renal colic
1334:Ureterocele
1253:MedlinePlus
473:Amoxicillin
449:Trade names
441:dextranomer
328:Cystography
266:Primary VUR
192:renal calyx
1422:Urethritis
1377:Trigonitis
1339:Megaureter
1329:Ureteritis
1218:DiseasesDB
922:: 508949.
778:Pediatrics
583:References
477:ampicillin
386:odds ratio
343:ultrasound
341:Abdominal
296:Functional
288:Anatomical
257:enter the
69:newspapers
1264:eMedicine
1229:SNOMED CT
1073:196420913
938:1687-6369
798:0031-4005
743:1442-200X
677:1442-2042
627:1046-6673
425:Treatment
311:Diagnosis
147:Specialty
99:July 2017
1544:Category
1527:Overflow
1362:Cystitis
1269:ped/2750
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396:Severity
363:prenatal
235:lethargy
1458:Any/all
1414:Urethra
1354:Bladder
1212:D014718
947:2478704
686:7318347
567:History
505:Bactrim
372:(UTI).
353:(DMSA)
255:ureters
216:bladder
196:kidneys
188:ureters
184:bladder
152:Urology
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1190:593.7
1175:N13.7
1069:S2CID
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573:Galen
231:fever
180:urine
90:JSTOR
76:books
1522:Urge
1207:MeSH
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1185:9-CM
1129:PMID
1092:ISBN
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