Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder into the ureter towards the kidney. Technically, it is the weakening or damage of the valve at the lower end of the ureter.
Causes
The cause of VUR may be chronic inflammation of the bladder (cystitis), which reduces the elasticity of the ureter walls, preventing the valve from closing. With excessive internal pressure in the bladder and weak fixation of the ureteral orifice, there is a shortening of the valve, which together leads to VUR. Vesicoureteral reflux in children may also be a consequence of certain congenital pathological changes in the bladder and ureter related to their connection.
Symptoms of Vesicoureteral Reflux
The first manifestation of VUR in children is acute pyelonephritis, which is accompanied by a rise in body temperature up to 38 degrees. The urine contains an increased amount of protein and leukocytes, while the blood shows an elevated leukocyte count and a high level of ESR. After inpatient treatment for pyelonephritis, the child is referred for urological examination. Less commonly, symptoms such as pain in the lower abdomen and lumbar region are observed. In newborns, a sign of VUR may be the dilation of the renal pelvis.
Diagnosis of Vesicoureteral Reflux in Israel
In Israel, the diagnosis of VUR is performed using voiding cystography with contrast material, which reveals the degree of reflux development, the patency of the urinary tract, and allows for the observation of signs of bladder dysfunction. Additional examination methods (laboratory tests, as well as cystoscopy, intravenous urography, and bladder examination) are the final touch in forming the clinical picture of the patient's disease.
Treatment of Vesicoureteral Reflux in Israel
Primary refluxes in Israel are treated by eliminating the damage at the beginning of the ureter using surgical or endoscopic methods. The first (surgical) method is currently unpopular as it is too traumatic and requires prolonged anesthesia. Endoscopy involves the introduction of a polymer that is neutral to human tissues at the ureteral orifice, which will form a valve support. The duration of the procedure is up to 15 minutes using light inhalational or local anesthesia. Thus, endoscopy has significant advantages - it is a non-invasive procedure, with a cure rate of 95%, and has no age-related contraindications.
Prevention
The prevention of VUR development is the earliest possible detection of the disease.