Dec 20, 2012

Vesicoureteral reflux (VUR)

Introduction:

Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children

Spontaneous resolution of VUR occurs in 78–90% of grades I–III VUR that is diagnosed during evaluation of antenatal hydronephrosis.

Grades IV and V may spontaneously resolve but usually require surgical intervention


Classification of vesicoureteral reflux (VUR)

Grade I- Reflux of urine in non dilated ureter
Grade II- Reflux of urine into a non dilated pelvis
Grade III- Reflux of urine into a dilated ureter up to the renal pelvis with possible blunting of calyceal fornices.
Grade IV- Reflux of urine into a grossly dilated ureter with moderate blunting of the calyces.
Grade V- Reflux of urine into a massively dilated and tortuous ureter with loss of the papillary impressio.
  
Management:

The objectives in the current treatment
the prevention of episodes of acute pyelonephritis with its associated morbidity and mortality.

to prevent the scarring of the kidney associated with vesicoureteral reflux (reflux nephropathy), which increases the risk of hypertension and renal failure.

Indications for surgical treatment

1.Breakthrough febrile UTIs despite adequate antibiotic prophylaxis
2. Severe reflux (grade V or bilateral grade IV) that is unlikely to spontaneously resolve,especially if renal scarring is present
3.Poor compliance with medications or surveillance programs
4.Poor renal growth or function or appearance of new scars. 



Surgical management of VUR : Ureteric Reimplantation:

Principle-Reconstruction of the ureterovesical junction (UVJ) to create a lengthened submucosal tunnel for the ureter,which functions as a one-way valve as the bladder fills

Types of Surgical repair:


Cohen procedure
Politano-Leadbetter
Lich-Gregoir,
Psoas hitch techni
que
 

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