jslum.

com | Medicine
Vesico-Ureteral Reflux (VUR)

Definition Investigations
Urine flows back in a retrograde fashion from Bladder → Kidneys Ultrasound of Kidney
Can detect dilatation in cases of VUR
Significance of Reflux But may show normal ultrasound in VUR, Scarring
↑ Incidence MCU (Micturating Cysto Urethrogram) (Male)
Somewhat less than 1% Bladder is catheterised
In 40% of Infants with UTI Contrast given in Bladder
↑ Frequent in Younger patients Patient asked to pass urine
Sequelae • Nice visualisation of bladder outline
Recurrent UTI • Nice visualisation of urethra
Renal failure (Damaged Kidney in small children) • Normally – No contrast move up
Hypertension Advantages Disadvantages
Degree of reflux demonstrated Gonadal irradiation
VUR causes UTI Good outline of Bladder, Urethra Not very sensitive
Ascending (almost always) Invasive
During micturition
• Urine goes out (excreted via urethra)
• Urine goes up (ascend to ureter)
Micturition ends when bladder is empty
After micturition, urine comes back into bladder (previously ascend to ureter)
Perineal colonisation
Urethral colonisation
Bladder col onisation Isotope Cystogram (Female)
Infrequent passing of urine Bladder catheterised
Incomplete bladder emptying Isotopes given in bladder
Cystitis • Camera can monitor during 1h
Pyelonephritis • ↓ good outline of Bladder wall and Urethra
• ↓ Radiation
UTI causes Renal Damage Advantages Disadvantages
Bacteria in Kidney → Inflammatory response ↑ Sensitive ↓ good outline of structures
Release inflammatory mediators – Toxins, O2 radicals ↓ Radiation Invasive
Ischaemia → Damage Kidney tissue
Immature Kidneys of Infants are more susceptible Management
Medical Surgical
Causes of VUR Correction & avoidance of risk factors Discuss with parents, surgeon
• Good Perineal Hygiene • Operation
• Normal Voiding Pattern • Laparoscopic (minimally
• Normal Bowel Habits invasive surgery)(keyhole)
• Endoscopi c
Antibiotics Prophylaxis Factors
(Once daily)(N octe – every night) • Age (Not in < 2 y/o with mild
• Trimetoprim reflux)
• Nitrofurantoin • Severity
• Cotrimoxazole • Persistence
• Cephalosporins • No. of breakthrough infections
Congenital Given until Reflux resolved • Bacterial resistance
Ureter enters bladder in oblique way Given until 7 y/o • Renal damage & progression
Congenital If fail, usually due to
Familial occurrence • Poor compliance
(Mother did not eat/ do anything wrong during pregnancy) • Resistant bacteria
Infrequent voiding
Neurogenic bladder
Cystitis

Clinical
Detected after UTI
Detected Antenally – Ultrasound shows dilated PC system