Symptoms
Symptoms of a UTI associated with VUR can include:
Fever
Frequent urination
Pain or burning during urination
Urgent need to urinate
Cloudy or bloody urine
Abdominal, flank (side), or back pain
Poor appetite (especially in infants)
Irritability (especially in infants)
Lethargy (especially in infants)
Bedwetting (in children who are already toilet trained)
Causes
Vesicoureteral Reflux (VUR):
Primary VUR: This is the most common type and is usually due to a defect in the valve-like mechanism where the ureter enters the bladder. This defect is often present at birth and may improve with age.
Secondary VUR: This is caused by a blockage or malfunction in the bladder or urethra. This obstruction causes increased pressure in the bladder, leading to urine reflux. Common causes include:
Posterior urethral valves (in males)
Bladder dysfunction (neurogenic bladder)
Severe constipation Urinary Tract Infections (UTIs):
UTIs are primarily caused by bacteria entering the urinary tract.
E. coli is the most common bacterial culprit.
In individuals with VUR, the abnormal urine flow makes it easier for bacteria to ascend and colonize the urinary tract.
Medicine Used
Antibiotics: These are the primary treatment for UTIs. Common antibiotics include:
Trimethoprim-sulfamethoxazole (Bactrim, Septra)
Nitrofurantoin (Macrodantin, Macrobid)
Cephalexin (Keflex)
Amoxicillin
Ciprofloxacin (Cipro) - Usually reserved for adults or complicated cases due to potential side effects in children.
Prophylactic Antibiotics: Low-dose antibiotics may be prescribed daily to prevent recurrent UTIs in individuals with VUR.
Medications for Bladder Dysfunction: If secondary VUR is caused by bladder dysfunction, medications like anticholinergics (e.g., oxybutynin) might be prescribed.
Is Communicable
Vesicoureteral reflux (VUR) itself is not communicable. It is a structural or functional abnormality. Urinary tract infections (UTIs) are generally not communicable from person to person. They are usually caused by bacteria that are already present in the body (e.g., in the digestive tract) and enter the urinary tract. However, rarely, some STIs can cause UTIs.
Precautions
For VUR and UTI prevention:
Good Hygiene: Proper wiping techniques (front to back for females) after using the toilet.
Adequate Hydration: Drinking plenty of fluids helps to flush bacteria from the urinary tract.
Frequent Urination: Avoiding holding urine for long periods.
Complete Bladder Emptying: Ensuring the bladder is fully emptied during urination.
Treat Constipation: Constipation can contribute to urinary problems.
Prophylactic Antibiotics: If prescribed by a doctor, take prophylactic antibiotics as directed.
Prompt Treatment of UTIs: Seeking medical attention and treatment at the first sign of a UTI.
Consider Circumcision: Circumcision in males reduces the risk of UTIs in infancy.
Avoid Bubble Baths and Harsh Soaps: These can irritate the urethra in some children.
Regular Follow-up: Following up with a doctor for monitoring and management of VUR.
How long does an outbreak last?
An outbreak in the context of VUR refers to the presence of a UTI.
With appropriate antibiotic treatment, a UTI typically begins to improve within 1-2 days.
Symptoms usually resolve completely within 1-2 weeks, depending on the severity of the infection and the antibiotic used.
How is it diagnosed?
Vesicoureteral Reflux (VUR):
Voiding Cystourethrogram (VCUG): This is the gold standard for diagnosing VUR. A catheter is inserted into the bladder, and a contrast dye is used to fill the bladder. X-rays are taken while the bladder is filling and while the child is urinating to see if the dye refluxes into the ureters and kidneys.
Radionuclide Cystogram (RNC): Similar to VCUG but uses a radioactive tracer instead of contrast dye. RNC involves less radiation.
Renal Ultrasound: This imaging technique can identify structural abnormalities in the kidneys and ureters, as well as signs of hydronephrosis (swelling of the kidneys). While ultrasound may suggest VUR, it cannot definitively diagnose it. Urinary Tract Infection (UTI):
Urine Dipstick: A quick test that detects the presence of nitrites, leukocytes, and blood in the urine.
Urine Culture: A urine sample is sent to a lab to identify the specific bacteria causing the infection and determine which antibiotics will be effective.
Timeline of Symptoms
UTI symptoms (with VUR):
Day 1-2: Initial symptoms such as frequent urination, burning sensation, and urgency may begin. Fever may also develop.
Day 2-3: Symptoms may worsen without treatment. Pain in the flank, back, or abdomen might become noticeable if the infection spreads to the kidneys.
Day 3 onward (with treatment): With antibiotics, symptoms typically start to improve within 1-2 days. Fever should subside, and urinary symptoms should gradually decrease.
1-2 Weeks: Symptoms should completely resolve within 1-2 weeks with appropriate antibiotic therapy.
Recurrent Infections: Without proper management of VUR, UTIs may recur.
Important Considerations
Long-term kidney damage: Recurrent UTIs associated with VUR, especially pyelonephritis (kidney infection), can lead to renal scarring and impaired kidney function.
Early diagnosis and management: Early detection and treatment of VUR are crucial to prevent complications.
Prophylactic antibiotics: The use of prophylactic antibiotics to prevent recurrent UTIs in children with VUR is controversial and should be discussed with a doctor to weigh the benefits and risks (e.g., antibiotic resistance).
Surgical correction: In some cases, surgery may be necessary to correct the anatomical abnormality causing VUR.
Monitoring: Regular monitoring of kidney function and urine analysis are important for individuals with VUR, even after treatment.
Parental education: Parents of children with VUR need to be educated about the condition, its potential complications, and the importance of adherence to treatment and follow-up.
Psychological impact: Recurrent UTIs can have a psychological impact on children and their families. Support and counseling may be helpful.