An abnormal flow of urine from the bladder back to the tubes (ureters) that are linked to the kidneys is called vesicoureteral reflux (also called hydronephrosis). In normal circumstances, the urine goes from the kidneys through the ureters into the bladder and never otherwise.
In most cases, this condition occurs in infants and children. Moreover, vesicoureteral reflux elevates the risk of urinary tract infections and without treatment may lead even to kidney failure.
However, children may outgrow a mild form of this condition. The most common treatment options include medicines and surgery to prevent kidney damage.
Symptoms
Urinary tract infections (UTIs) commonly happen in people with hydronephrosis. A UTI does not always cause symptoms but most people experience the following ones. For example:
- Persistent urge to urinate
- A burning sensation while urinating
- Cloudy urine
- Fever
- Abdominal pain
Usually, it is challenging to diagnose a UTI in children, especially if they do not experience symptoms. In most cases, when infection occurs, it may cause the following symptoms. Examples include:
- Irritability
- Lack of appetite
- Unexplained fever
When your child grows, the following symptoms may occur, especially if vesicoureteral reflux is not treated. Check below some examples:
- Protein in the urine
- Hypertension (high blood pressure)
- Constipation
- Loss of control of the bowel movements
- Bed-wetting
Healthcare professionals may detect this health problem before birth using a sonogram. It helps identify kidney swelling and other health issues.
Immediately contact your healthcare provider if the following symptoms occur. For example belly pain, a strong urge to urinate, and a fever higher than 100.4 F or 38 C degrees.
Causes
The urinary system consists of kidneys, ureters, bladder, and urethra and all play an important role in removing waste products from the body. Normally, the urine goes from the kidneys to the bladder through certain tubes called ureters and stays there until it leaves the body through another tube called the urethra.
Vesicoureteral Reflux Types
There are two types of hydronephrosis. For example:
- Primary vesicoureteral reflux – Commonly, children with the primary type of this condition are born with a valve defect that keeps urine from flowing back into the ureters. Moreover, this is the most common type of this condition. In most cases, this condition runs in families.
- Secondary vesicoureteral reflux – This type of hydronephrosis usually occurs due to a blockage or failure of the bladder muscle, damage to the nerves that control the bladder, or when the bladder is not emptying completely.
Risk Factors
The following factors may elevate your risk of vesicoureteral reflux. Examples include:
- Bladder and bowel dysfunction (BBD) – Recurrent urinary tract infections and BBD may contribute to vesicoureteral reflux.
- Race – White people are more prone to develop this condition.
- Sex – Women are at higher risk of developing vesicoureteral reflux compared to men.
- Age – Children and infants under 2 years old are more likely to develop this condition.
- Family history – People with a family history of primary vesicoureteral reflux are at increased risk of developing it. Discuss with your healthcare professional if you have a parent or sibling with this condition.
What Are The Possible Complications of Vesicoureteral Reflux?
Check below some complications that may occur in people with hydronephrosis:
- Kidney scarring – If UTIs are left untreated, it may lead to scarring of the liver tissues. In other words, permanent damage to the kidney tissue occurs.
- High blood pressure – Hypertension usually occurs due to damage to the kidneys that cannot remove waste from the bloodstream.
- Kidney failure – scarring of the kidney tissue may lead to loss of function in the kidney filtering part. As a result, kidney failure may happen.
Diagnosis
In most cases, doctors perform a urine test to determine if your child has a UTI. However, other tests may be necessary. For example:
- Bladder and kidney ultrasound – This test uses sound waves to make pictures of the kidneys and bladder, which help doctors identify abnormalities. It also can be used during pregnancy to diagnose primary vesicoureteral reflux in the baby.
- Specialized X-ray of the urinary system – This test helps determine abnormalities when the bladder is not fully emptying. It involves a small tube with a camera on the end that is inserted through the urethra into the bladder.
- Nuclear scan – It involves a tracer (also known as a radioisotope) that helps how well the urinary system works. However, discomfort while urinating are common risk associated with this test.
Treatment
The treatment your doctor will prescribe depends on the severity and type of the condition. While children may outgrow primary vesicoureteral reflux, in severe cases treatment may include surgery and medicines. For example:
Medicines
Commonly, UTIs are treated with antibiotics that help keep the infection from going away from the kidneys. This group of medicines also is used to prevent urinary tract infections. Regular monitoring is recommended for children who use antibiotics until the treatment ends. These include physical examinations, urine tests, and radiographic scans (occasionally) because UTIs may happen even with treatment.
Surgery
This procedure is usually used to repair the defective valve located between the bladder and the affected ureter. This defect prevents the valve from closing properly, which allows urine to flow backward. Check below some surgery types often used to repair the valve:
- Open surgery – This procedure involves general anesthesia because surgeons make an incision in the lower abdomen. Therefore, surgeons will repair the problem. Commonly, an open surgery requires several days of staying in the hospital.
- Robotic-assisted laparoscopic surgery – This surgery is very similar to open surgery. In both procedures, surgeons make incisions in the abdominal region to repair the affected valve. The only difference between these surgeries is that incisions are smaller than those required for open surgery.
- Endoscopic surgery – During this surgery, doctors will insert a tube (also called a cystoscope) through the urethra to see inside the bladder and thereafter inject a bulking agent that usually helps strengthen the ability of the valve to close completely. Endoscopic surgery is a minimally invasive procedure compared to open surgery but it may be not as effective and also requires general anesthesia.
Frequently Asked Questions
What are the main symptoms of vesicoureteral reflux?
These include:
- Cloudy or bloody urine
- Frequent urinating
- Burning sensation when urinating
- Pain in the abdomen (belly)
- Vomiting
- Stomach upset
- Poor weight gain
- Hypertension
If you notice any of the symptoms listed above, immediately visit a doctor.
What are the potential complications of vesicoureteral reflux?
Those who suffer from this condition may also experience certain complications. These include:
- Urinary incontinence or retention
- Permanent damage to the kidneys (scarring)
- Kidney failure
- Protein in the urine
Discuss with your healthcare professional if you experience vesicoureteral reflux complications.
How vesicoureteral reflux is treated?
Sometimes, children may outgrow the condition if they experience a mild form of the condition. In more severe cases, doctors usually recommend surgery and medications to relieve the symptoms and improve your quality of life. Ask your healthcare provider if you have additional questions.
