Summary about Disease
Ureteral reflux, also known as vesicoureteral reflux (VUR), is a condition where urine flows backward from the bladder into one or both ureters, and sometimes even up to the kidneys. Normally, a valve-like mechanism at the junction of the ureter and bladder prevents this backflow. VUR can increase the risk of urinary tract infections (UTIs) and, in severe cases, kidney damage (reflux nephropathy). It is more common in infants and young children.
Symptoms
Many children with VUR, especially those with mild cases, may have no noticeable symptoms. When symptoms do occur, they are often related to UTIs. These can include:
Frequent UTIs
Fever
Pain in the side, abdomen, or groin
Burning sensation during urination
Frequent urination
Urgent need to urinate
Bedwetting (in older children)
Cloudy or foul-smelling urine
In infants: poor feeding, unexplained fever, irritability
Causes
The most common cause of primary VUR is a defect in the valve-like mechanism at the junction of the ureter and bladder (the vesicoureteral junction). This defect is often congenital, meaning it is present at birth. Secondary VUR can be caused by:
Blockage in the bladder or urethra
Dysfunctional voiding (problems with bladder emptying)
Neurogenic bladder (nerve damage affecting bladder control)
Medicine Used
The primary medication used in managing VUR is antibiotics. These are typically administered in low doses daily (prophylactic antibiotics) to prevent UTIs, which can further damage the kidneys. Common antibiotics used include:
Trimethoprim-sulfamethoxazole (Bactrim, Septra)
Nitrofurantoin (Macrobid, Macrodantin)
Cephalexin (Keflex) In cases of severe blockage, medications to manage bladder spasms or other underlying conditions might be prescribed.
Is Communicable
Ureteral reflux itself is not communicable. It's not an infectious disease and cannot be spread from person to person. However, the UTIs that can result from VUR are caused by bacteria, and while not directly communicable through casual contact, proper hygiene is essential to prevent the spread of the bacteria that cause UTIs.
Precautions
Proper hygiene: Teach children (and practice good hygiene yourself) to wipe from front to back after using the toilet.
Frequent urination: Encourage regular and complete bladder emptying. Avoid "holding it" for long periods.
Hydration: Drink plenty of fluids to help flush bacteria from the urinary tract.
Constipation prevention: Treat constipation as it can worsen bladder issues.
Follow medical advice: Adhere to the prescribed antibiotic regimen and attend all follow-up appointments with the doctor.
How long does an outbreak last?
Ureteral reflux is not an "outbreak" in the traditional sense. It is a chronic condition. However, the UTIs associated with VUR are acute infections that typically last for several days to a couple of weeks with appropriate antibiotic treatment. The underlying reflux may persist for years and might resolve spontaneously (especially in lower grades) or require surgical intervention.
How is it diagnosed?
Voiding cystourethrogram (VCUG): This is the gold standard for diagnosing VUR. A catheter is inserted into the bladder, and the bladder is filled with a contrast dye. X-rays are taken while the bladder is filling and while the child is urinating. This allows doctors to see if urine is flowing backward into the ureters.
Renal ultrasound: This imaging technique can identify kidney abnormalities and hydronephrosis (swelling of the kidney due to urine backup), which may suggest VUR. It's often used as a screening tool before VCUG.
Radionuclide cystography (RNC): This test uses a radioactive tracer instead of contrast dye and may involve less radiation exposure than a VCUG.
Timeline of Symptoms
The timeline of symptoms depends on whether VUR is associated with a UTI.
No UTI: The child may be asymptomatic, and the VUR might be discovered incidentally during evaluation for other conditions.
UTI:
Onset: Symptoms like fever, pain, and urinary symptoms typically appear within a day or two.
Progression: If untreated, the infection can worsen, potentially leading to kidney infection (pyelonephritis) and more severe symptoms.
Resolution: With appropriate antibiotic treatment, symptoms usually improve within 24-48 hours and resolve completely within a week or two.
Recurrence: UTIs may recur frequently in children with VUR if prophylactic antibiotics are not used or if the underlying reflux is not addressed.
Important Considerations
Early diagnosis is crucial: Early detection and treatment can help prevent kidney damage.
Grading of VUR: VUR is graded on a scale of I to V, with I being the mildest and V being the most severe. The grade influences treatment decisions.
Spontaneous resolution: Mild VUR (grades I and II) often resolves spontaneously over time, especially in younger children. Regular monitoring is important.
Surgical options: Surgery may be considered for severe VUR (grades IV and V) or if UTIs continue to occur despite antibiotic prophylaxis. The most common surgical procedure is ureteral reimplantation.
Long-term follow-up: Children with VUR require long-term monitoring to assess kidney function and detect any complications.