Vesicoureteral reflux ruwida
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Transcript of Vesicoureteral reflux ruwida
Vesicoureteral Reflux
is the retrograde flow of urine from the bladder into
the upper urinary tract with or without dilation of ureters ,renal pelvis and
calyces .
Vesicoureteral reflux
Is that Normal ???
Normally Reflux is prevented by : • low bladder Pressure .• Efficient ureteric peristalsis . • The ability of the
vesicoureteric junction to occlude the distal ureter during bladder contraction .
• The ureters pass obliquely through the bladder wall (intramural part ).
Vesico uretal Reflux Primary is a defect where the intramural part length is
too short ( ratio < 5:1 )
Secondary Iatrogenic
Following TURP
Functional
Detrusor instability, neurogenic bladder and Urinary tract infections .
Anatomical
Bladder Outlet obstruction
Predisposition
• Although VUR is more common in males antenatally , in later life there is a definite female preponderance with 85% of cases being female.
• VUR has higher predisposition in siblings ranged from 4.7- 51 % , which is higher than general population 1 % .
• Younger children are more prone to VUR because of the relative shortness of the sub-mucosal ureters. This susceptibility decreases with age as the length of the ureters increases as the children grow.
Clinical presentation • Asymptomatic , discovered accidently .• Lower UTI symptoms . • Fever , chills , loin and abdominal pain, nausea and
vomiting .• Loin pain associated with a full bladder or
immediately after micturation . • Recurrent UTI or Loin pain for years .• Antenatal : Hydronephrosis .• Renal Failure , Hypertension .
Why Reflux is a Problem ?
• Recurrent UTI , Cystitis , Pyelonephritis .
• Hydroureteronephrosis. • Renal scarring. • hypertension. • Renal failure.
Investigations :
Blood : CBC : ↑ WBC → Infection . ↑ Urea , ↑ Creatinie → Renal Impairment Urine analysis : Proteinuria , Radiological : Abdominal ultrasound , specially
antenatal ,young children . Cystography . MCUG : Grading IVU Cytoscopy Radionucleotide scanning : DMSA Scanning
Management depends on : Presence & severity of symptoms .Presence of recurrent infections . Presence of established renal damage .
Recurrent UTI Recurrent UTI Recurrent UTINo symptoms
between UTI Attacks less than 3 Years
No symptoms between UTI Attacks
less than 3 Years.Constitutional symptoms :
Acute pyelonephritis rather than cyctitis
Reflux into non-functioning Kidney (<10 % on DMSA ) .
Normal RFT Normal RFT Deteriorated RFT up normal RFT NO HTN NO HTN HTN
Treat UTI when they occur , give prophylactic
antibiotic
Ureteric implantation Ureteric implantation
Nephroureterectomy
Primary VUR
• Treat the underlying cause … • Patients with no UTI , No high Bladder
pressure → controversial because it’s not known whether low pressure sterile reflux cause deterioration over years .
Secondary VUR
Thanks for Your attention
Ruwida M. S.Ashour Alorfy