Vesicouretic reflux
Encyclopedia
Vesicouretic reflux is a condition in which normal compression of the bladder
during urination results in an abnormal backflow of urine into the kidney
s. It is the second most common renal disease in children. Over a period of weeks, months or years, this leads to kidney infection
, permanent scar
ring of kidney tissue, high blood pressure, and if left untreated, renal failure
. It is a congenital defect related to the bladder and/or ureters (tubes that carry urine from the kidneys to the bladder) and can be hereditary.
Low-grade reflux often resolves on its own as the child grows, and this type of reflux does not require surgery —however close monitoring and special antibiotics must be administered.
High-grade reflux can benefit from surgery, of which a selection of techniques are described below.
Bladder augmentation
to reduce pressure in the bladder during urination.
Ureter repositioning has emerged in the 1990s. Ureter repositioning is less complicated to perform than bladder augmentation and so far has proved to suffer from less complications post surgery. The refluxing ureter or urinary tube is repositioned or re-implanted in the bladder wall. The end of the ureter is surrounded by bladder muscle in this new position in the bladder, which prevents urine from refluxing toward the kidneys.
See also Bladder reconstruction / Substitution cecocystoplasty.
Until treatment is performed, an indwelling catheter
should be left temporarily inserted to evacuate urine as soon as it begins to collect in the bladder to prevent further kidney damage due to reflux.
from the digestive tract may also be a problem due to unactivated vitamin D
. Again, calcium or activated vitamin D supplements can reduce this problem.
Ureter repositioning suffers less complications than bladder augmentation and is usually more desirable. The complications of bladder augmentation are usually avoided and this treatment offers the best quality of life for the patient post-surgery.
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
during urination results in an abnormal backflow of urine into the kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
s. It is the second most common renal disease in children. Over a period of weeks, months or years, this leads to kidney infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, permanent scar
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...
ring of kidney tissue, high blood pressure, and if left untreated, renal failure
Renal failure
Renal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
. It is a congenital defect related to the bladder and/or ureters (tubes that carry urine from the kidneys to the bladder) and can be hereditary.
Treatment
Depending on the severity of the reflux, surgery is usually recommended.Low-grade reflux often resolves on its own as the child grows, and this type of reflux does not require surgery —however close monitoring and special antibiotics must be administered.
High-grade reflux can benefit from surgery, of which a selection of techniques are described below.
Bladder augmentation
Bladder augmentation
Bladder augmentation is a surgical alteration of the urinary bladder. It involves removing strips of tissue from the intestinal tract and adding this to the tissue of the bladder...
to reduce pressure in the bladder during urination.
Ureter repositioning has emerged in the 1990s. Ureter repositioning is less complicated to perform than bladder augmentation and so far has proved to suffer from less complications post surgery. The refluxing ureter or urinary tube is repositioned or re-implanted in the bladder wall. The end of the ureter is surrounded by bladder muscle in this new position in the bladder, which prevents urine from refluxing toward the kidneys.
See also Bladder reconstruction / Substitution cecocystoplasty.
Until treatment is performed, an indwelling catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
should be left temporarily inserted to evacuate urine as soon as it begins to collect in the bladder to prevent further kidney damage due to reflux.
Prognosis
Provided an early diagnosis occurs, prognosis is usually excellent, and a large part of kidney function can be saved, depending on the treatment chosen. If kidney damage has already occurred, high blood pressure may be present and this must be controlled to prevent further damage to the kidneys. This can be controlled with medication. Absorption of calciumCalcium in biology
Calcium plays a pivotal role in the physiology and biochemistry of organisms and the cell. It plays an important role in signal transduction pathways, where it acts as a second messenger, in neurotransmitter release from neurons, contraction of all muscle cell types, and fertilization...
from the digestive tract may also be a problem due to unactivated vitamin D
Vitamin D
Vitamin D is a group of fat-soluble secosteroids. In humans, vitamin D is unique both because it functions as a prohormone and because the body can synthesize it when sun exposure is adequate ....
. Again, calcium or activated vitamin D supplements can reduce this problem.
Ureter repositioning suffers less complications than bladder augmentation and is usually more desirable. The complications of bladder augmentation are usually avoided and this treatment offers the best quality of life for the patient post-surgery.