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Vesicoureteral reflux

Normally, urine (the liquid waste of the body) flows one way and down from the kidney then into tubes (called ureters) and get stored in the bladder. When someone voids, it is drained from the bladder to outside

If some drainage of the urine flows the wrong way (i.e. back towards the kidneys) from the bladder during voiding, this is called Vesicoureteral reflux (VUR). 

VUR can be Primary or Secondary

Primary VUR is a congenital condition as the ureter(s) did not grow long enough before birth and anti-reflux mechanism of ureter within the bladder wall is deficient. It is present since birth and found in infants and young children. About 1 to 3 percent of children in the world are suffering from this disease. 

Secondary VUR occurs when there is an obstruction while emptying bladder or in the urethra, causing urine to flow backward into the kidneys. Secondary VUR can occur at any age and can be caused by a pattern of emptying the bladder that’s not normal(usually in paeditric age groups),congenital anomalies(like Posterior Urethral valves-a type of obstruction in urethra), surgery or injury causing obstruction while passing urine.

Kidney damage is the primary concern with VUR. The more severe the reflux, the more severe complications are likely to be there. 

Symptoms may include 

  • Fever
  • Pain in flank or abdomen 
  • Cloudy urine 
  • Persistent urge to urinate 
  • Burning sensation while urinating
  • Passing small amount of urine frequently 
  • Bed-wetting 

Complications may include 

  • Kidney/ Renal scarring 
  • High blood pressure 
  • Kidney failure 

The reflux sometimes resolves overtime usually within five years. Children are usually kept on long term antibiotic prophylaxis till resolution of reflux and require constant follow-up.

If during Follow-up, reflux grade is increasing along with recurrent symptomatic Urinary tract infections or new formation of kidney scars, need surgical intervention to prevent Kidney damage.

Child’s reflux can be corrected with the help of the surgery and can be prevented from urine flowing back to the kidney. Some cases may include the use of bulking injections. A small amount of gel-like liquid into the bladder wall near the opening of the ureter. 

In cases of severe grades of reflux or failure after bulking agents, will need surgery to re-implant the refluxing ureter in the bladder in a proper anti-refluxing way. This can be achieved with Laparoscopic means (Key-hole surgery)