Vesicoureteral Reflux (VUR)
Terms in this set (6)
Most common cause of pyelonephritis in children
Bladder pressure increases → urine refluxes into ureter & renal pelvis
1. Occurs most often at peak bladder pressure during voiding
2. Can occur as bladder fills & remain after voiding, even draining down into bladder, leaving residual urine until next void
Primary reflux (congenital)
Issue with ureterovesical junction, abnormal tunneling of ureteral segment, or defects in ureter orifice
Significant familial pattern and high incidence in siblings.
Reflux can be asymptomatic; so all siblings should be screened!
Secondary reflux (acquired)
o UTI can produce temporary reflux
o Neurogenic bladders or dysfunctional voiding (ie myelomeningocele)
1. It is diagnosed with VCUG.
2. Suspect in young males with UTI
3. In most cases of VUR conservative nonoperative therapy is effective in controlling infection
[there is a high rate of spontaneous resolution over time]
4. Continuous abx prophylaxis (based on assumption that the abx will make urine sterile, so the reflux of sterile urine won't cause renal damage)
5. Surgical management of VUR corrects anatomy of refluxing ureter into the bladder and consists of open surgical correction with reimplantation of the ureters, or endoscopic correction
---Surgery recommended in pts unlikely to resolve reflux and at risk for renal scarring
a) grade V reflux with scarring
b) grade V reflux over 6 years old
c) children who fail medical therapy
Support parents in adherence to medical therapy (chronic antibiotics and frequent evaluation of urine for infection)