Vesicouretic reflux is a condition in which normal compression of the bladder during urination results in an abnormal backflow of urine into the kidneys. It is the second most common renal disease in children.^[1] Over a period of weeks, months or years, this leads to kidney infection, permanent scarring of kidney tissue, high blood pressure, and if left untreated, renal failure. It is a congenital defect related to the bladder and/or ureters, and can be hereditary.

Symptoms

Painful urination and recurrent symptoms of kidney infection.

Treatment

Depending on the severity of the reflux, surgery is usually recommended.

Low grade reflux often resolves on its own as the child grows, and this type of reflux does not require surgery - however close monitoring and special antibiotics must be administered.

High grade reflux can benefit from surgery, of which a selection of techniques are described below.

Bladder augmentation to reduce pressure in the bladder during urination.

Ureter repositioning has emerged in the 1990s. Ureter repositioning is less complicated to perform than bladder augmentation and so far has proved to suffer from less complications post surgery. The refluxing ureter or urinary tube is repositioned or re-implanted in the bladder wall. The end of the ureter is surrounded by bladder muscle in this new position in the bladder, which prevents urine from refluxing toward the kidneys.

See also Bladder reconstruction / Substitution cecocystoplasty.

Until treatment is performed, an indwelling catheter should be left temporarily inserted to evacuate urine as soon as it begins to collect in the bladder to prevent further kidney damage due to reflux.

Prognosis

Provided an early diagnosis occurs, prognosis is usually excellent and a large part of kidney function can be saved, depending on the treatment chosen. If kidney damage has already occurred, high blood pressure may be present and this must be controlled to prevent further damage to the kidneys. This can be controlled with medication. Absorption of calcium from the digestive tract may also be a problem due to unactivated vitamin D. Again, calcium or activated vitamin D supplements can reduce this problem.

Ureter repositioning suffers less complications than bladder augmentation and is usually more desirable. The complications of bladder augmentation are usually avoided and this treatment offers the best quality of life for the patient post-surgery.

References

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