Vesicoureteric Reflux 

DEFINITION 

 

Vesicoureteric reflux (VUR) is a condition where the join between the ureter and the bladder is abnormal and allows urine to flow backwards from the bladder in to the ureter during bladder contraction, or during passive filling of the bladder with urine. In people without VUR, urine drains from the kidney, down the ureter and into the bladder and is not able to pass from the bladder in to the ureter again.  

 

VUR can affect one kidney, both kidneys, and can have a range of severity. It may predispose your child to Urinary Tract Infections (UTI). Patients with mild VUR may be completely asymptomatic. Severe VUR is associated with progressive kidney scarring, kidney failure, dialysis and renal transplant.  

 

GOALS OF CARE 

 

Management of VUR is focused on medical and surgical treatments to; 

 

  • Reduce or prevent severe UTI 

  • Limit the progression of kidney scarring 

  • Reduce the risk of Kidney Failure 

 

 

OUTCOMES 

 

If your child is diagnosed with VUR as a newborn, it is expected that the severity of the VUR may decrease over time, or even resolve without intervention.  

 

Most children with VUR never require surgical intervention. 

 

OUR APPROACH 

 

Some patients may be offered a low dose antibiotic for the first 12 months of their life to reduce the risk of UTI. If your child has already had a UTI, then antibiotic therapy will be recommended based on the organism that is grown in their urine. 

 

Dr Rob offers circumcision to boys with intermediate VUR and/or a history of UTI as it has been shown to effectively reduce the risk of UTI in boys who have a predisposition to it. 

 

Once your child is over 12 months of age, and especially once they are toilet trained, the risk of complications from VUR reduces. For some cases, observation, antibiotics and circumcision are not sufficient. 

 

Deflux(R) is a procedure where an injection in to the Ureteric Orifice (where the ureter enters the bladder) is made using an inert material to narrow the ureter and reduce reflux by creating a valve like mechanism. It is a day procedure which is well tolerated and has few side effects. It is very successful in cases of intermediate severity VUR. 

 

Ureteric Reimplantation is an operation where the ureter is disconnected from the bladder, tunnelled through the bladder wall to create a valve, and then reattached to the inside of the bladder. Dr Rob performs this as an open operation through an incision that is similar to the scars seen in Caesarian Section. This is a significant reconstructive procedure reserved for severe cases, and requires a stay in hospital of 3-7 days.