Vesicoureteric reflux

2017 ◽  
Author(s):  
David F.M. Thomas
Keyword(s):  
Urinary Tract ◽  
Renal Damage ◽  
Surgical Intervention ◽  
Vesicoureteric Reflux ◽  
Upper Urinary Tract ◽  
Retrograde Flow ◽  
Increased Risk ◽  
Endoscopic Correction ◽  
Transport Of Bacteria

The term vesicoureteric reflux (VUR) describes the retrograde flow of urine from the bladder into the upper urinary tract. VUR is not a disease entity in its own right. Nevertheless, it has the potential to cause significant morbidity by preventing effective emptying of the urinary tract and by facilitating the transport of bacteria into the upper tract and renal parenchyma. Mechanisms of renal damage associated with VUR include pyelonephritic scarring and congenital dysplasia or hypoplasia. The long-term complications of pyelonephritic scarring may include hypertension, renal failure, and an increased risk of complications during pregnancy. VUR of mild or moderate severity is best managed conservatively and surgical intervention is generally reserved for failed medical management and high grade or complex VUR. Although the introduction of endoscopic correction has revolutionized surgical management, there remains a role for open surgery for the correction of higher grades of reflux.

Primary vesicoureteric reflux and reflux nephropathy

2018 ◽  
Author(s):  
Heather Lambert
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Vesicoureteric Reflux ◽  
Reflux Nephropathy ◽  
Ureterovesical Junction ◽  
Increased Risk ◽  
History Of ◽  
Tract Infections

Vesicoureteric reflux (VUR) describes the flow of urine from the bladder into the upper urinary tract when the ureterovesical junction fails to perform as a one-way valve. Most commonly, VUR is primary, though it can be secondary to bladder outflow obstruction and can occur in several multiorgan congenital disorders. There is good evidence of a genetic basis with a greatly increased risk of VUR in children with a family history of VUR. VUR is a congenital disorder, which largely shows improvement or complete resolution with age. Fetal VUR may be associated with parenchymal developmental defects (dysplasia). Postnatally non-infected, non-obstructed VUR does not appear to have a detrimental effect on the kidneys. However there is an association of VUR with urinary tract infection and acquired renal parenchymal defects (scarring). The parenchymal abnormalities detected on imaging, often termed reflux nephropathy, may be as a result of reflux-associated dysplasia or acquired renal scarring or both. It is difficult to distinguish between the two on routine imaging. Higher grades of VUR are associated with more severe reflux nephropathy. The precise role of VUR in pyelonephritis and scarring is not clear and it may be that VUR simply increases the risk of acute pyelonephritis. Whilst most VUR resolves during childhood, it is associated with an increased risk of urinary tract infection and burden of acute disease. Investigation strategies vary considerably, related to uncertainties about the natural history of the condition and the effectiveness of various interventions. The long-term prognosis is chiefly related to the morbidity of reflux nephropathy leading in some cases to impairment of glomerular filtration rate, hypertension, proteinuria, and pregnancy-related conditions including hypertension, pre-eclampsia, and recurrent urinary tract infection. Management is controversial and ranges from simple observation with or without provision of rapid access to diagnosis and treatment of urinary tract infections; to long-term prophylactic antibiotics or various antireflux surgical procedures.

Urinary tract infection in children

2017 ◽  
Author(s):  
David F.M Thomas
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Renal Damage ◽  
Vesicoureteric Reflux ◽  
Asymptomatic Bacteriuria ◽  
Clinical Excellence ◽  
Low Grade ◽  
Dysfunctional Voiding

Urinary tract infection (UTI) is one of the commonest conditions of childhood, affecting an estimated 10% of girls and 3% of boys in the first 16 years of life. Whereas asymptomatic bacteriuria and low-grade lower tract infection pose little or no risk of renal damage, pyelonephritis can cause severe systemic illness and poses a significant threat of long-term renal morbidity. The principal aim of investigation is to identify underlying abnormalities of the urinary tract, notably vesicoureteric reflux. Guidelines on investigation and management published by the National Institute of Clinical Excellence will be reviewed in this chapter. Treatment of dysfunctional voiding and other features of ‘elimination syndrome’ plays an important role in the prevention of urinary tract infection in this age group.

Urinary tract infection in infancy and childhood

2018 ◽  
Author(s):  
Heather Lambert
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Acute Pyelonephritis ◽  
Renal Scarring ◽  
Vesicoureteric Reflux ◽  
Adult Life ◽  
Urinary Tract Abnormality ◽  
Increased Risk

Urinary tract infection (UTI) in childhood is a common problem, which is frequently dismissed as trivial because most children with UTI have a good outcome. However, UTI is an important cause of acute illness in children and causes a considerable burden of ill health on children and families. In addition, UTI may be a marker of an underlying urinary tract abnormality. UTI in a few may cause significant long-term morbidity, renal scarring, hypertension, and renal impairment that may not present until adult life. Predicting which children will go on to have long-term sequelae remains a challenge.The risk of renal scarring is greatest in infants, the very group in whom diagnosis is often overlooked or delayed because clinical features are non-specific. Delay in treatment is associated with an increased risk of scarring in susceptible children. Thus accurate and rapid diagnosis of UTI is essential and requires a very high index of suspicion particularly in the youngest.The role of vesicoureteric reflux in acquired scarring is not fully understood though there is clearly an association, possibly because it is a risk factor for acute pyelonephritis. Scarring when it occurs is in the areas affected by acute pyelonephritis. Higher grades of reflux are associated with a worse outcome.Management and investigation of children with UTI consumes considerable healthcare resources. Limited understanding of the natural history and basic pathophysiology, variations in strategy with time and setting, and lack of evidence on long-term outcomes have resulted in considerable uncertainty. Some propose a minimal approach doing little investigation unless there is clear evidence for it; others favour an approach of continuation of current practice based on clinical experience until further evidence evolves. Some of the themes behind these controversies are explored.

scholarly journals Treatment of vesicoureteric reflux in children

2021 ◽  
pp. 21-27
Author(s):  
Kh. Ibodov ◽  
T. Sh. Ikromov ◽  
K. M. Mirakov ◽  
K. M. Sayyodov ◽  
R. Rofiev ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Vesicoureteral Reflux ◽  
Vesicoureteric Reflux ◽  
Upper Urinary Tract ◽  
Synthetic Material ◽  
Results Of Treatment ◽  
Grade Ii ◽  
Endoscopic Correction ◽  
Positive Results ◽  
Grade Iii

Aim. To study the efficacy of endoscopic correction of vesicoureteric reflux in children using bulk synthetic material.Material and methods. From 2016 to 2020, we studied the results of treatment of 63 children with vesicoureteric reflux. The children ranged in age from 6 months to 17 years. The degree of vesicoureteral reflux was as follows: grade I was observed in 2 (3.1%) patients, grade II in 16 (25.3%), grade III in 30 (47.6%), grade IV in 13 (21.98%), and grade V in 2 (3.1%). Among 63 patients with CKD, grade I was found in 26 (41.3%), grade II - in 16 (25.4%); grade III - in 13 (20.6%); grade V - in 2 (3.1%). - III stage - 13 (20,6%); IV stage - 8 (12,7%); IV stage - 4 (12,6%). - (12,7%), and there were no patients with V stage of CKD were absent. Unilateral vesicoureteric reflux was noted in 45 (71.4%) children, bilateral - in 18 (28.5%) children. Endoscopic intravesical correction of vesicoureteral reflux was performed by suburethral injection of “Dam+”.Results and discussion. Summarizing the results of our study, it should be noted that positive results were achieved concerning the relief of urinary tract infection, elimination of urine outflow from the upper urinary tract, improvement of renal function after PMR correction using “Dam+”. Positive results of VUR correction amounted to 75,01%.Conclusions. Endoscopic correction of VUR is one of the effective and low-traumatic methods of treatment. Application of the biocompatible synthetic material “Dam+” in the correction of vesicoureteric reflux contributes to positive results.

Disorders of the kidney and upper urinary tract in children

2017 ◽  
Author(s):  
Kim Hutton
Keyword(s):  
Urinary Tract ◽  
Vesicoureteric Reflux ◽  
Upper Urinary Tract ◽  
Outcome Data ◽  
Multicystic Dysplastic Kidney ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Dysplastic Kidney ◽  
Clinically Significant

The majority of clinically significant congenital disorders of the upper urinary tract are now detected prenatally. Commonly identified abnormalities include pelviureteric junction obstruction (PUJO), vesicoureteric junction obstruction (VUJO), duplication anomalies, multicystic dysplastic kidney (MCDK), high grade vesicoureteric reflux (VUR) and anomalies of renal migration and/or fusion. Most affected infants are asymptomatic at birth and further investigation can usually be undertaken on a non-urgent basis in the first few weeks or months of life. Long-term natural history studies have shown that many of these conditions can be managed non-operatively. In most cases, standardized procedures such as pyeloplasty and ureteric reimplantation give predictably satisfactory results. Long-term outcome data for surgical and conservative management of upper tract disorders in children is sparse and research in this area is still required.

Is Ileal Orthotopic Bladder Substitution with an Afferent Tubular Segment Detrimental to the Upper Urinary Tract in the Long Term?

2002 ◽  
Vol 168 (5) ◽  
pp. 2030-2034 ◽  
Author(s):  
HARRIET C. THOENY ◽  
MARTIN J. SONNENSCHEIN ◽  
STEPHAN MADERSBACHER ◽  
PETER VOCK ◽  
URS E. STUDER
Keyword(s):  
Urinary Tract ◽  
Upper Urinary Tract ◽  
Bladder Substitution

scholarly journals Long-Term Lithium Use and Risk of Renal and Upper Urinary Tract Cancers

2015 ◽  
Vol 27 (1) ◽  
pp. 249-255 ◽  
Author(s):  
Anton Pottegård ◽  
Jesper Hallas ◽  
Boye L. Jensen ◽  
Kirsten Madsen ◽  
Søren Friis
Keyword(s):  
Urinary Tract ◽  
Upper Urinary Tract

scholarly journals Ureteral Involvement and Diabetes Increase the Risk of Subsequent Bladder Recurrence after Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Che-Yuan Hu ◽  
Yu-Chieh Tsai ◽  
Shuo-Meng Wang ◽  
Chao-Yuan Huang ◽  
Huai-Ching Tai ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Cox Model ◽  
Medical Center ◽  
Upper Urinary Tract ◽  
Increased Risk ◽  
The Impact ◽  
Bladder Recurrence ◽  
Urinary Tract Urothelial Carcinoma

Objectives.To investigate the prognostic factors for bladder recurrence after radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UUT-UC).Methods.From 1994 to 2012, 695 patients with UUT-UC treated with RNU were enrolled in National Taiwan University Medical Center. Among them, 532 patients with no prior bladder UC history were recruited for analysis. We assessed the impact of potentially prognostic factors on bladder recurrence after RNU.Results.The median follow-up period was 47.8 months. In the Cox model, ureteral involvement and diabetes mellitus (DM) were significantly associated with a higher bladder recurrence rate in the multivariate analysis (hazard ratio [HR]: 1.838;P=0.003and HR: 1.821;P=0.010, resp.). In the Kaplan-Meier analysis, DM patients with concomitant ureteral UC experienced about a threefold increased risk of bladder recurrence as compared to those without both factors (HR: 3.222;P<0.001). Patients with either of the two risk factors experienced about a twofold increased risk as compared to those without both factors (with DM, HR: 2.184,P=0.024; with ureteral involvement, HR: 2.006,P=0.003).Conclusions.Ureteral involvement and DM are significantly related to bladder recurrence after RNU in patients with UUT-UC.

URINARY TRACT INFECTION IN CHILDREN

PEDIATRICS ◽  
1969 ◽  
Vol 44 (5) ◽  
pp. 677-684
Author(s):  
Duncan E. Govan ◽  
John M. Palmer
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Hospital Admissions ◽  
Upper Urinary Tract ◽  
Cure Rate ◽  
Before And After ◽  
Tract Infections ◽  
Urethral Dilation

To study the influence of successful ureterovesicoplasty on incidence of recurrent urinary infection, two groups of infected children were compared in this regard before and after urologic evaluation. Of 280 new pediatric urologic hospital admissions, 55.6% had urinary tract infections. Sixty-six of these 156 infected children had vesicoureteral reflux. Bacteriologic localization of infection site was performed in both children with and without reflux at the time of diagnostic cystoscopy. Both groups were specifically treated with short-term antibiotic therapy and empiric urethral dilation. Operative vesicoureteroplasty was carried out in 62 children with reflux, with an overall cure rate of 83.8%. Distal urethral stenosis was not a contributing factor in this population nor did urethral caliber relate to the incidence of reflux. Only 3 of 35 children without reflux were found to have bacteriologically proved upper urinary tract infection. Similarly, only 32% of these children without reflux had clinical histories suggestive of recurrent pyelonephritis. In the children with reflux undergoing bacteriologic localization while infected, no nonrefluxing ureters were found infected, and only one third of the refluxing ureters so studied had proved upper urinary tract infection. Historical evidence for clinical pyelonephritis was present in 79% of the population with reflux; but, after successful cure of reflux, only 7% of these children continued to have pyelonephritic episodes. The long-term incidence of recurrent urinary tract infection was virtually identical, however, in the children undergoing successful antireflux surgery and the children without reflux following ureteral dilation. This relationship indicates that reflux plays little role in the etiology of bacteriunia but has a profound influence on urinary tract infection morbidity in children.

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