Surgery for vesicoureteral reflux

Vesicoureteral Reflux

Vesicoureteral Reflux is re-entrance of the urine into the kidneys once it has left the kidneys and entered the bladder. This problem affects the both genders, girls predominantly. The disease is usually discovered soon after the birth.

Certain abnormalities or obstruction of the bladder are causes of vesicoureteral reflux. This condition leads to recurrent urinary infections. During these infections the ultrasonography of the urinary tract can show enlargement of the collective system of the kidneys. This can point to the presence of vesicoureteral reflux. The specific test that will definitely confirm the diagnosis is the voiding cystourethrogram. This test uses a contrast which helps the doctor to visualize the whole urinary tract especially abnormalities and the doctor can clearly see the reflux of the urine from the bladder into the affected kidney.

The reflux can lead to repeated infections of the urinary tract with consequent scarring. If the scarring affects kidneys their function can be seriously jeopardized and the person may eventually develop chronic kidney failure and problems with elevated blood pressure.

The doctors believe that vesicoureteral reflux occurs during intrauterine development. The actual problem is in the structure of the ureter which is supposed to contract not allowing the urine to return into the kidneys.

Treatment for Vesicoureteal Reflux

The treatment basically depends on the stage of the disease. The disease is classified into 5 stages. The mildest forms withdraw on their own and the only treatment for these patients includes prevention of urinary infection. This is maintained until the symptoms of vesicoureteral reflux have subsided. A low dose of antibiotics is given to a child every night. The antibiotics that are given include cotrimoxizole or Macrodantin. In children under the age of 2 amoxicillin is the most prescribed antibiotic.

Surgery for Vesicoureteral Reflux

Surgical repair is performed in advanced stage of the disease. Grade 4 and 5 of the disease are always surgically treated. The surgery is additionally performed in patients with recurrent infections of the urinary tract in spite of application of antibiotics. And finally, in persistent cases of moderate disease the surgery can be performed as well.

The surgery is successful in general, but there is a chance of certain complications such as obstruction of one or both ureters and chronic reflux. The obstruction can be only temporary and there is usually no need for additional operation to treat this complication. Additional complications include bleeding and infection of the incision line.

After the surgery patients go to yearly ultrasound of the urinary tract. This examination confirms or rules out the success of the surgery.