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Definition:
The passage of urine from the bladder back up the ureter.
Anatomy:
The ureter, the hollow tube that carries urine to the bladder, traverses the
wall of the bladder diagonally which allows increased bladder pressure to
close it, thus preventing reflux. In children with reflux, this valve mechanism
is defective.
Treatment:
May be medical surveillance or surgical repair and is based on the severity
of the reflux, the kidney function, and the presence of other abnormalities.
Follow Up:
All children will need:
-
-Urinalysis
(UA) every eight weeks
-
-UA whenever
child has fever of 38.5 C or above
-
-Urine culture
for any abnormal UA
-
-Repeat studies:
US every six months and VCUG or nuclear cystogram yearly thereafter to follow
improvement, detect resolution or deterioration. All documented breakthrough
infections must be reported to your pediatric urologist so that appropriate
management adjustments can be made.
Indications
for surgery:
-
-Noncompliance
with medical regimen
-
-Repeated
breakthrough infections
-
-High grade
reflux
-
-Evidence
of significantly reduced renal function at time of presentation
-
-Evidence
of significant renal scarring at time of presentation
-
-Evidence
of other anatomic defects which would make resolution of reflux unlikely
-
-Deterioration
of function or increase in degree of reflux during follow-up
-
-No improvement
over several years of surveillance
Surgery:
There are many different operative procedures used to repair reflux. Most
common are:
-
Intravesicle
repair: the ureter is completely freed from the bladder and tunneled under
the bladder lining to its new location. The bladder is open for this repaid.
-
Extravesicle
repair: The ureter is freed from the bladder muscle from the outside of
the bladder but left attached to the bladder lining. It is then laid down
in a groove of bladder muscle which is closed over the ureter, thus creating
a longer tunnel. A catheter is left in the bladder for 2-5 days. A small
drain may be left in the abdomen and removed once it stops draining after
the catheter has been removed. Most children are able to go home in 2-5
days. Occasionally, the bladder catheter may need to be reinserted and the
child may go home with the catheter for up to a few weeks; this occurs more
commonly if a surgical repair was done on both sides.
Follow Up
After Surgery: Assuming no complications, the child will return for an
office visit 2-3 weeks following surgery. A renal ultrasound will be done
around four weeks after surgery and a VCUG or nuclear cystogram at twelve
weeks following surgery. Yearly renal ultrasound may be done for a few years
thereafter.
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