Vesicoureteral reflux (VUR), or the retrograde flow of urine from the bladder into the ureter, is an anatomic and functional disorder that can result in substantial morbidity, both from acute infection and from the sequelae of reflux nephropathy.
Vesicoureteral reflux (VUR) is characterized by the retrograde flow of urine from the bladder to the kidneys. VUR may be associated with urinary tract infection (UTI), hydronephrosis, and congenital/secondary abnormal urinary tract development (duplications of ureters, horseshoe kidney, neurogenic bladder).
Unrecognized VUR with concomitant UTI may lead to long-term effects on renal function and overall patient health. Some individuals with VUR are at an increased risk for pyelonephritis, hypertension, and progressive renal failure. However, the severity of VUR greatly varies and thus may affect patients differently. Evaluation of VUR treatment outcomes should consider not only resolution of reflux over time but also resolution of UTIs and the overall health of the kidneys.
The goal of treatment is to minimize infections, as it is infections that cause renal scarring and not the vesicoureteral reflux. When medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive renal scarring then surgical interventions may be necessary. There are two main surgical interventions for pediatric VUR include endoscopic injection of hyaluronic acid (Trade name, Deflux) and open procedures for ureter reimplantation.
- Stenosis of reimplanted ureteral orifice
- Irritable urinary bladder after open procedure
- Recurrence of VUR and infection
- General risk of anesthesia