A vesicoureteral reflux is the retrograde outflow of urine from the bladder into the ureter and the collection system.
A vesicoureteral reflux is the retrograde outflow of urine from the bladder into the ureter and the collection system. Etiology Vesicoureteral reflux occurs in most cases due to a congenital developmental anomaly of ureterovesical connection. Incomplete development of intramural ureteric tunnel leading to the failure of the flap-like mechanism on the ureterovesical reconciliation and allows the reflux of bladder urine into the ureter and renal pelvis. A reflux can occur even at normal tunneling when the intravesical pressure due to Blasenausgangsstenose or a disturbed urination increases. A disturbed urination is irregular urination, constipation or both, which may delay the disappearance of a vesicoureteral reflux. Pathophysiology A reflux of urine from the bladder into the ureter predisposed to damage to the upper urinary tract by bacterial infections and increased hydrostatic pressure. Bacteria from the lower urinary tract can easily be reached from the reflux in the upper urinary tract and have there Parenchyminfektionen with possible scar formation. Renal scarring can eventually sometimes lead to hypertension and renal dysfunction. Vesicoureteral reflux is a common cause of urinary tract infections in children, about 30-40% of infants and young children with urinary tract infections have a vesicoureteral reflux. Symptoms and discomfort children usually come with a history of fetal hydronephrosis or with a urinary tract infection in the treatment or if they are being studied as siblings. Rare children with hypertension to the doctor. Hypertension is very common long-term consequence of renal scarring. Children with urinary tract infection may include fever, abdominal or flank pain, dysuria, frequent urination, urgency, oozing or rarely hematuria have. Diagnostic sonography Miktionszystourethrographie Sometimes scintigraphy A urinalysis and culture should be performed to detect infections. In infants and young children a catheterized sample is required. The evaluation includes: ultrasonography of the kidneys, ureter and bladder before and after emptying, fluoroscopic Miktionszystourethrographie. With an ultrasound of the kidneys the size of the kidneys, hydronephrosis and scarring can be found. The Miktionszystourethrographie is used to diagnose vesicoureteral reflux and to other abnormalities of the bladder to be clarified. A radioisotope cystogram is performed to monitor reflux. If necessary, an infection or scarring good scintigraphy (dimercapto-succinic acid) can be demonstrated the renal parenchyma also very. Urodynamic studies may show an increased intravesical pressure if necessary. Reflux results to be displayed on Miktionszystourethrographie are classified on a scale of I-V (s. Severities of vesicoureteral reflux). The degree of reflux can be influenced by the capacity of the bubble and the bubble dynamics. Weak: grade I and II means: Grade III Severe: Grade IV and V Treatment Sometimes antibiotic prophylaxis in some cases injection of a filler or ureteral reimplantation A mild to moderate vesicoureteral reflux often disappears spontaneously after months to several years. It is very important that the children are free from infection. Until recently, children were given with mild to moderate vesicoureteral reflux daily antibacterial prophylaxis, but there is currently no consensus on this practice. Most pediatric urologist recommended for severe vesicoureteral reflux antibiotics for all ages as well as vesicoureteral reflux of grade II-V in children under 2 years. However, the American Academy of Pediatrics does not recommend prophylaxis for children with vesicoureteral reflux of grade I-IV. There are several alter- and weight-based recommendations for antibiotics but is usually children or trimethoprim sulfamethoxazole before bedtime, nitrofurantoin over dinner or prescribed 2 times daily cephalexin. A severe reflux, which is accompanied by high intravesical pressures is with anticholinergics (eg. As oxybutynin, solifenacin succinate), rarely with surgery (such as botulinum toxin or bladder extension) treated. Patients with bowel and bladder dysfunction benefit from behavioral therapy with or without biofeedback. A symptomatic reflux (recurrent infections, reduced renal growth, renal scarring) should be with an endoscopic injection substanzvermehrenden an agent (eg. B. dextranomer / hyaluronic acid), or treated with a urethral reimplantation. Monitoring history, physical examination (including blood pressure measurement), laboratory testing with urinalysis and serum creatinine and imaging with ultrasound and voiding cystourethrogram be made at regular intervals depending on the age of the child and the severity of the reflux and related complications. Usually every 4-6 months is made (more common in children with significant nephropathy in the ultrasound visible) sonography in children under 2 years. In older children, ultrasonography every 6-12 months is done. Miktionszysturethrogramme be repeated (longer intervals at higher grade vesicoureteral reflux, VUR bilateral and / or older children) every 1-2 years. In addition, dry expectant children should be examined at every visit to constipation and irregular urination, as well as to incontinence, urinary urgency and nocturnal enuresis. These are common signs of emptying disorder is treated with behavioral therapy and / or drug therapy. Summary Vesicoureteral reflux is in most cases the result of a congenital developmental abnormality of ureterovesical transition. A reflux of urine from the bladder into the ureter may cause infections of the upper urinary tract. Approximately 30-40% of infants and young children with UTI have VUR. Diagnostic with Miktionszysturethrogramms. Monitoring with serial sonography and Miktionszysturethrogrammen. A mild to moderate vesicoureteral reflux often heals spontaneously, but more severe disease may require surgical intervention. Children with newly diagnosed vesicoureteral reflux receive prophylactic antibiotics, depending on their clinical course. Dry expectant children should be tested for voiding disorders and are treated accordingly.