Vesicoureteral reflux

Symptoms and causes

What is a vesicoureteral reflux?

Urine produced by the kidneys drains into the bladder through the ureters. This is where the urine is stored until the appropriate time to urinate through the urethra. Normally, there are ureters and bladder valves at the transition that prevent urine from the bladder from flowing back into the kidneys. If these valves do not develop correctly, backflow of urine from the bladder to the ureters and kidneys is possible; this is called vesico-ureteral reflux (VUR). It is an innate problem that can arise on one or both sides.

VUR typically does not cause any symptoms or damage. However, it is important to note that in case of a bladder infection, the inflamed urine may flow back to the kidneys and cause kidney inflammation. When kidney inflammation occurs, the child is seriously ill and permanent damage to the kidneys may occur.

VUR occurs in 1-2% of children, primarily girls. If VUR has caused serious damage to the kidneys, reflux nephropathy can occur. Reflux nephropathy is the cause of kidney dysfunction and high blood pressure.

Diagnosis and treatment

How is the diagnosis determined?

Ultrasound of kidneys and bladder
Nuclear kidney scan
Cystourethrography

How is vesicoureteral reflux treated?

A watchful-waiting approach

Many types of VUR will spontaneously improve and even disappear. For these types of VUR, a watchful-waiting approach without active treatment is preferable. During the watchful waiting period, prevention of urinary inflammation is, of course, of the utmost importance in order to avoid kidney inflammation with kidney damage. That is why it is often recommended to take a low dose of antibiotics every day for a long period of time in order to keep the urine free of inflammation.

Surgical treatment

Reasons to opt for a surgical approach:

Serious breakthrough inflammation while the child is already taking preventive antibiotics.
Difficulties with the intake of preventive antibiotics.
Repeated imaging (cystography) reveals worsening of the VUR.
VUR persists after a considerable period of waiting.

There are two surgical options for the treatment of VUR:

Deflux or STING procedure

If it is necessary to perform surgery for reflux, an endoscopic approach (i.e. without skin incision) is usually adopted. In such a Deflux or STING operation under general anaesthesia, a small implant is injected under the opening of the ureter into the bladder. This solves the problem of urine backflow. This procedure is performed by cystoscopy (visual examination of the bladder). Skin incision, therefore, is not necessary and this procedure can normally be performed in a day hospital. The STING operation has a high chance of success, but in some children one injection is not enough. And sometimes surgical ureter reimplantation is still necessary. In this procedure, a skin incision is made in the lower abdomen under general anaesthesia, the bladder is opened and the ureter-bladder transition is created again.