Visicoureteral reflux

It is the passage of urine from the bladder to the ureters and / or kidneys, depending on the severity.

Under normal conditions, urine is formed in the kidney, from there it passes to the ureters, the bladder and from the urethra to the outside. The junction of the bladder with each ureter is called the vesicoureteral junction and its function is to prevent the opposite passage of urine (from bladder to ureters).

Reflux is said to occur when this mechanism fails and urine returns to the ureters and / or the kidney from the bladder.

Causes

The cause is a malformation of the urinary tract at the level of the vesicoureteral junction. The baby has the defect from birth. Most often, it heals on its own over time.

Symptoms

Reflux as such does not cause symptoms but can be the cause of recurrent pyelonephritis (infection and inflammation of the kidney).

It can also be a cause of hydronephrosis (the ureters swell and fill with urine).

There are five levels of vesico-ureteral reflux depending on the affectation and severity. The more severe the reflux the higher the degree:

Diagnosis

The diagnosis of reflux is made by chance when a child under the age of five suffers from pyelonephritis and a study is carried out to rule out whether or not he has vesico-ureteral reflux.

The procedure used to study the presence of reflux is cystography or cystourethrography (CUMS) and consists of inserting a contrast visible on the X-ray through the urethra with a probe. The test is considered normal if the ureters are not filled with this substance (it is not seen on the x-ray). This malformation can also be suspected during routine pregnancy ultrasounds.

Treatment

Grades I, II, and III usually heal on their own over time around 5 years. While awaiting healing and monitoring with imaging tests, the child should be given a prophylactic antibiotic to prevent possible pyelonephritis.

If the reflux does not disappear after five years or it is a grade IV or V reflux, surgery should be done.

The prevention of new pyelonephritis is very important because as the inflammation of the kidney heals, it produces a scar that can compromise kidney function.