Vesicoureteral reflux

Vesicoureteral reflux

V esicoureteral reflux (VUR) is the retrograde flow of urine from the bladder to the upper urinary tracts. Primary VUR occurs because of a congenitally short intravesical ureter, resulting in inadequate closure of the UVJ during bladder contractions, and is seen in 1% of newborns. Secondary VUR follows from elevated intravesical pressure and is typically caused by PUV or -

(a) (b) (c) (d) Figure 20.5 (a) Preoperative ultrasound of a right kidney with uretero

pelvic junction obstruction showing hydronephrosis. (b) Preoperative mercaptoacetyltriglycine (MAG-3) activity curve showing delayed excretion of the obstructed right kidney with a half-life of 26 minutes.

(c) Ultrasound image of the right kidney after a pyeloplasty showing resolution of the hydronephrosis. (d) Postoperative MAG-3 activity curve graph showing improved excretion with a half-life of 7.6 minutes.

a neurogenic bladder. VUR may be seen with hydronephrosis on an antenatal ultrasound or with a symptomatic UTI postna tally . A voiding cystourethrogram establishes the diagnosis and severity of VUR ( Figure 20.7 ). Mild VUR typically resolves spontaneously as the patient grows and the intravesical ur matures and lengthens. These children are managed with surveillance if toilet-trained or prophylactic antibiotics if they are not. Moderate-to-severe VUR less commonly resolves and recurrent UTIs may lead to pyelonephritis and renal paren chymal loss from scarring. Persistent or severe VUR can be managed with a subureteric Teflon injection (STING), which alters the anatomy at the UVJ and limits reflux, or with ureteric reimplantation. Long-term follow-up is r equired.

C B A Figure 20.6 A retrograde pyelogram showing a left-sided ureteroves ical junction obstruction (A), causing a megaureter (B) and hydro nephrosis (C) .

Vesicoureteral reflux

V esicoureteral reflux (VUR) is the retrograde flow of urine from the bladder to the upper urinary tracts. Primary VUR occurs because of a congenitally short intravesical ureter, resulting in inadequate closure of the UVJ during bladder contractions, and is seen in 1% of newborns. Secondary VUR follows from elevated intravesical pressure and is typically caused by PUV or -

(a) (b) (c) (d) Figure 20.5 (a) Preoperative ultrasound of a right kidney with uretero

pelvic junction obstruction showing hydronephrosis. (b) Preoperative mercaptoacetyltriglycine (MAG-3) activity curve showing delayed excretion of the obstructed right kidney with a half-life of 26 minutes.

(c) Ultrasound image of the right kidney after a pyeloplasty showing resolution of the hydronephrosis. (d) Postoperative MAG-3 activity curve graph showing improved excretion with a half-life of 7.6 minutes.

a neurogenic bladder. VUR may be seen with hydronephrosis on an antenatal ultrasound or with a symptomatic UTI postna tally . A voiding cystourethrogram establishes the diagnosis and severity of VUR ( Figure 20.7 ). Mild VUR typically resolves spontaneously as the patient grows and the intravesical ur matures and lengthens. These children are managed with surveillance if toilet-trained or prophylactic antibiotics if they are not. Moderate-to-severe VUR less commonly resolves and recurrent UTIs may lead to pyelonephritis and renal paren chymal loss from scarring. Persistent or severe VUR can be managed with a subureteric Teflon injection (STING), which alters the anatomy at the UVJ and limits reflux, or with ureteric reimplantation. Long-term follow-up is r equired.

C B A Figure 20.6 A retrograde pyelogram showing a left-sided ureteroves ical junction obstruction (A), causing a megaureter (B) and hydro nephrosis (C) .

Vesicoureteral reflux

V esicoureteral reflux (VUR) is the retrograde flow of urine from the bladder to the upper urinary tracts. Primary VUR occurs because of a congenitally short intravesical ureter, resulting in inadequate closure of the UVJ during bladder contractions, and is seen in 1% of newborns. Secondary VUR follows from elevated intravesical pressure and is typically caused by PUV or -

(a) (b) (c) (d) Figure 20.5 (a) Preoperative ultrasound of a right kidney with uretero

pelvic junction obstruction showing hydronephrosis. (b) Preoperative mercaptoacetyltriglycine (MAG-3) activity curve showing delayed excretion of the obstructed right kidney with a half-life of 26 minutes.

(c) Ultrasound image of the right kidney after a pyeloplasty showing resolution of the hydronephrosis. (d) Postoperative MAG-3 activity curve graph showing improved excretion with a half-life of 7.6 minutes.

a neurogenic bladder. VUR may be seen with hydronephrosis on an antenatal ultrasound or with a symptomatic UTI postna tally . A voiding cystourethrogram establishes the diagnosis and severity of VUR ( Figure 20.7 ). Mild VUR typically resolves spontaneously as the patient grows and the intravesical ur matures and lengthens. These children are managed with surveillance if toilet-trained or prophylactic antibiotics if they are not. Moderate-to-severe VUR less commonly resolves and recurrent UTIs may lead to pyelonephritis and renal paren chymal loss from scarring. Persistent or severe VUR can be managed with a subureteric Teflon injection (STING), which alters the anatomy at the UVJ and limits reflux, or with ureteric reimplantation. Long-term follow-up is r equired.

C B A Figure 20.6 A retrograde pyelogram showing a left-sided ureteroves ical junction obstruction (A), causing a megaureter (B) and hydro nephrosis (C) .