Overview
Vesicoureteral reflux is a medical condition in which urine flows abnormally from the bladder back up the tubes (ureters) that connect the kidneys to the bladder. This disorder is typically diagnosed in infants and children and increases the risk of urinary tract infections (UTIs). Untreated UTIs can lead to kidney damage. Children may outgrow primary vesicoureteral reflux. Treatment aims to prevent kidney damage, which can include medication or surgery.
Understanding the disease
Symptoms
The symptoms of vesicoureteral reflux can include a strong, persistent urge to urinate and a burning sensation when urinating. Vesicoureteral reflux increases the risk of urinary tract infections, which may have additional signs and symptoms such as a need to pass small amounts of urine frequently, cloudy urine, fever, pain in the side or abdomen, and nonspecific symptoms in infants like an unexplained fever, lack of appetite, and irritability. As the child grows older, untreated vesicoureteral reflux may lead to bed-wetting, constipation, loss of control over bowel movements, high blood pressure, and protein in the urine. If you suspect your child has vesicoureteral reflux, it's important to contact a doctor right away.
Risk Factors
Risk factors for vesicoureteral reflux include:
- Bladder and bowel dysfunction (BBD): Children with BBD may hold their urine and stool, leading to recurrent urinary tract infections, which can contribute to vesicoureteral reflux.
- Race: White children appear to have a higher risk of vesicoureteral reflux.
- Sex: Generally, girls have a higher risk of developing this condition than boys. However, boys have a higher risk if the reflux is present at birth.
- Age: Infants and children up to age 2 are more likely to have vesicoureteral reflux than older children.
- Family history: Primary vesicoureteral reflux tends to run in families, so children whose parents had the condition and siblings of children with primary vesicoureteral reflux are at higher risk. Vesicoureteral reflux can develop in two types: primary and secondary. Primary vesicoureteral reflux is more common and typically has a genetic component. Secondary vesicoureteral reflux is often caused by a failure of the bladder to empty properly, due to blockages or bladder muscle dysfunction.
Development
Vesicoureteral reflux (VUR) can develop in two types: primary and secondary.
- Primary vesicoureteral reflux: Children with primary VUR are born with a defect in the valve that normally prevents urine from flowing backward from the bladder into the ureters. This type of VUR is more common and tends to run in families, suggesting a genetic component. As the child grows, the ureters lengthen and straighten, which may improve valve function and eventually correct the reflux.
- Secondary vesicoureteral reflux: This form of VUR is caused by a failure of the bladder to empty properly due to blockage or failure of the bladder muscle or damage to the nerves that control normal bladder emptying. It is important to note that while primary VUR is often genetic, the exact cause of the defect is unknown. Secondary VUR, on the other hand, is typically caused by a non-genetic factor such as bladder or bowel dysfunction, race, sex, age, or family history.
Assessment and Diagnosis
Triage
Seek immediate medical care if you experience chest pain, especially if you also have shortness of breath, or jaw or arm pain, as these may be signs and symptoms of a heart attack. If you have suspected vesicoureteral reflux, it is important to consult a doctor for proper diagnosis and treatment. Make an appointment with your doctor if you or your child experiences severe or frequent symptoms related to vesicoureteral reflux, such as a strong, persistent urge to urinate, a burning sensation when urinating, or urinary tract infections.
Diagnosis
Vesicoureteral reflux can be diagnosed through various tests, including a urine test to identify a urinary tract infection, kidney and bladder ultrasound to detect structural abnormalities, and a specialized X-ray of the urinary tract system. These tests can help determine the presence and severity of vesicoureteral reflux.
Management and Treatment
Complications
Complications of vesicoureteral reflux may include kidney damage, high blood pressure, and kidney failure. Untreated urinary tract infections can lead to kidney scarring, which can cause permanent damage to kidney tissue. This damage can result in high blood pressure and, in extreme cases, kidney failure. The risk factors for vesicoureteral reflux include bladder and bowel dysfunction, race, sex, age, and family history. Primary vesicoureteral reflux is more common and tends to run in families, while secondary vesicoureteral reflux often results from a blockage or failure in bladder emptying.
Prevention
Vesicoureteral reflux cannot be prevented as it is a congenital condition caused by a defect in the valve that prevents urine from flowing backward from the bladder into the ureters. Primary vesicoureteral reflux tends to run in families, suggesting a genetic component, but the exact cause of the defect is unknown. Secondary vesicoureteral reflux may be prevented by addressing the underlying cause, such as ensuring proper bladder emptying or treating blockages, but primary vesicoureteral reflux is not preventable. Early diagnosis and treatment of vesicoureteral reflux can help prevent complications like kidney damage and urinary tract infections.
Home Remedies
It is important to seek medical advice and follow the treatment plan recommended by a healthcare professional for managing vesicoureteral reflux.
Treatment
Treatment for vesicoureteral reflux aims to prevent kidney damage and may include medication or surgery. The primary treatment options are:
- Medications: Antibiotics are commonly prescribed to prevent and treat urinary tract infections associated with vesicoureteral reflux. Medications may also be used to help relax the bladder and prevent reflux.
- Surgery: Surgery may be necessary for severe cases of vesicoureteral reflux, especially if medications are not effective. Common surgical options include ureteral reimplantation, where the ureters are repositioned to prevent reflux, and injection of a bulking agent into the area around the ureters to strengthen the valve. It is important to note that children with primary vesicoureteral reflux may outgrow the condition as they grow, as the ureters lengthen and straighten, potentially improving valve function. However, consult a healthcare professional for personalized advice and monitoring of the condition.
Preparing for medical consultation
To prepare for an appointment for vesicoureteral reflux, follow these steps:
- Make the appointment: Contact your healthcare provider to schedule an appointment for your child.
- Gather information: Collect relevant information about your child's symptoms, medical history, and any family history of urinary tract conditions.
- Prepare a list of questions: Create a list of questions to ask your child's doctor during the appointment. Some questions to consider include:
- What's the most likely cause of my child's signs and symptoms?
- What are the possible complications of vesicoureteral reflux?
- What tests will be performed to confirm the diagnosis?
- What treatment options are available for my child, and what are their benefits and risks?
- Is surgery necessary, and what can we expect from the procedure?
- Are there any lifestyle or dietary changes that can help manage symptoms?
- Bring a family member or friend: Consider bringing a family member or friend to the appointment, if possible, to help remember the information discussed and provide support.
- Prepare for the appointment: Refrain from alcohol and caffeine before the appointment to avoid dry mouth and throat. By following these steps, you can help ensure that you have a productive and informative appointment with your child's doctor.