Vesicoureteral Reflux

In this condition, urine—which normally flows from the kidneys to the bladder via the ureters—abnormally refluxes upward due to the malfunction of the valve mechanism at the lower end of the ureter where it enters the bladder.

How common is it?

It is a common congenital disorder with an incidence of 1%. In children with recurrent urinary tract infections, the prevalence ranges from 30% to 50%. In infants diagnosed with renal enlargement (hydronephrosis) in utero via ultrasound, the prevalence is found to be 16%. The likelihood of occurrence in children with a sibling diagnosed with VUR is 27%, while in children with parents who have VUR, the incidence is approximately 35%.

Diagnosis

The diagnosis is made during the evaluation of children who have had a febrile urinary tract infection or who were diagnosed with renal enlargement (hydronephrosis) in utero.

Voiding cystourethrogram (VCUG): This examination, commonly referred to as a "catheterized film," is the most important and informative test to perform for diagnosis. A contrast medium is introduced into the bladder via a catheter, and images are taken intermittently to assess whether there is any reflux while the bladder fills and empties. If vesicoureteral reflux is present, it is graded on a scale from 1 to 5 based on its severity.

In children diagnosed with vesicoureteral reflux, tests such as urinary ultrasound, renal scintigraphy (DMSA), and urodynamic studies may be required to assess the condition of the kidneys and bladder.

Why is Vesicoureteral Reflux Important?

This condition is an anatomical and/or functional disorder that can lead to serious consequences such as kidney damage, hypertension, and renal failure.

Vesicoureteral reflux does not cause kidney damage in children who have not had a urinary tract infection and whose bladder is functioning normally. Therefore, the main goal of treatment is to preserve kidney function by taking measures to reduce the risk of kidney infections.

Treatment

Non-Surgical (Conservative) Treatment: The main goal is to prevent febrile urinary tract infections. A large percentage of children with low-grade vesicoureteral reflux resolve spontaneously. In five-year follow-ups, 80% of children with grade 1 and 2 reflux, and 30-50% of those with grade 3-5 reflux, show spontaneous resolution.

Antibiotic prophylaxis: It is the long-term administration of antibiotics at lower doses than those used for treatment, aimed at preventing urinary tract infection.

Toilet training: The child should be encouraged to use the toilet every 2-3 hours both at home and at school, ensuring regular urination. The child should sit in an appropriate position on the toilet, with feet flat on the ground, and, if necessary, a support placed under the feet to help relax the pelvic floor muscles and ensure complete emptying of the bladder and bowels. Fluid intake should be evenly distributed throughout the day. If constipation is present, it must be addressed.

Circumcision in early childhood in male children is part of the conservative approach as it helps protect against infection.

Surgical Treatment

Dolgu maddelerinin endoskopik enjeksiyonu (STING): Sistoskop ile mesane içine girilip üreter ağzına dolgu maddesi enjeksiyonu yapılması işlemidir. Günübirlik kısa süreli bir işlem olup, başarı oranı tekrarlayan enjeksiyonlarla %85’e çıkmaktadır.
Ureteral Reimplantation Surgery: This procedure involves creating a tunnel at the lower end of the ureter and, if necessary, reimplanting it into the bladder. There are several surgical techniques described for this procedure, and the success rate is approximately 98%.