Bladder-ureter reflux (VUR)
The vesicoureteral reflux (VUR) is a urinary tract disorder that is particularly common among infants and children. This condition is based on an anomaly of the urinary tract, which causes urine to flow back into the ureter and even into the renal pelvis. As a result of the reflux, children may experience frequent urinary tract infections, which can lead to serious long-term health problems if not properly treated.
The anatomical abnormalities underlying VUR are related to the positioning and closing mechanism of the ureter. Normally, urine flow through the ureter is unidirectional, but this mechanism can be disrupted due to reflux. Treatment of the condition is of significant importance, as untreated cases can lead to serious complications, including reduced kidney function and chronic infections.
VUR can be congenital or acquired, and the method of treatment depends on the stage of the disease. It is important for parents to be aware of the symptoms, as early diagnosis and intervention can significantly improve the chances of recovery.
Symptoms and Complications of Vesicoureteral Reflux
The most characteristic symptom of vesicoureteral reflux is the occurrence of frequent urinary tract infections. If a child experiences recurrent urinary tract infections, it is worth considering the possibility of reflux. Other nonspecific signs of the disease may include failure to gain weight, bedwetting, or even unexplained fever and pain. If the inflammation spreads to the renal pelvis, symptoms of acute pyelonephritis may also appear, which require urgent medical intervention.
If reflux persists for a longer period, children generally present with vague, nonspecific symptoms such as headaches, lethargy, nausea, or even weight loss. The development of complications is less common due to modern medical diagnostics and treatment, but untreated cases can lead to serious problems such as renal failure or sepsis. Long-term reflux can result in stagnant urine in the renal pelvis, which promotes the proliferation of bacteria, leading to further inflammation.
Classification and Diagnosis of Vesicoureteral Reflux
Vesicoureteral reflux is classified into five different stages, reflecting the severity of the condition. In stage I, urine flows back into the ureter, while in stage II, it also reaches the renal pelvis. In stage III, dilation can already be observed, while stages IV and V show more significant dilation of the renal pelvis and twisting of the ureter.
Diagnosis typically begins with an ultrasound examination; however, this does not always provide clear results. A contrast X-ray examination provides much more accurate information about the condition of the urinary tract. The most reliable method is cystography, during which the bladder is filled with contrast material, making the severity of the reflux visible on the X-ray. Additionally, a urine test is necessary due to urinary tract infections, which shows an increase in the number of bacteria and signs of inflammation.
Treatment Options for Vesicoureteral Reflux
Treatment of vesicoureteral reflux is essential, as the condition can have serious consequences. In infants, it is common for the condition to show spontaneous improvement, but treatment options can be divided into stages. In stages I and II, the first step is the sustained disinfection of urine, which can help eliminate the reflux, thereby reducing the risk of inflammation.
In more severe cases, such as stages III and IV, if medication is ineffective, surgical intervention may be necessary. One common method is the endoscopic procedure, which is performed through the urethra, allowing for examination of the anatomical position of the ureter. If the ureteral opening is dilated, biocompatible materials are injected under the mucosa to narrow the opening. If this does not yield results, there is also the option of a higher-risk open surgical intervention aimed at restoring the abnormal anatomical position.
Therefore, the treatment of vesicoureteral reflux is a complex process that requires thorough medical supervision and appropriate diagnosis to preserve the child’s health.
