Vesicoureteral reflux
| Vesicoureteral reflux | |
|---|---|
 |
|
| Ultrasound image showing abnormal vesicoureteral junction and dilated distal ureter resulting in primary vesicoureteral reflux (VUR). | |
| Classification and external resources | |
| Specialty | urology |
| ICD-10 | N13.7 |
| ICD-9-CM | 593.7 |
| DiseasesDB | 13835 |
| MedlinePlus | 000459 |
| eMedicine | ped/2750 |
| MeSH | D014718 |
Vesicoureteral reflux (VUR) is a condition in which urine flows retrograde, or backward, from the bladder into the ureters/kidneys. Urine normally travels in one direction (forward, or anterograde) from the kidneys to the bladder via the ureters, with a 1-way valve at the vesicoureteral (ureteral-bladder) junction preventing backflow. The valve is formed by oblique tunneling of the distal ureter through the wall of the bladder, creating a short length of ureter (1–2 cm) that can be compressed as the bladder fills. Reflux occurs if the ureter enters the bladder without sufficient tunneling, i.e., too "end-on".
Most children with vesicoureteral reflux are asymptomatic. Vesicoureteral reflux may be diagnosed as a result of further evaluation of prenatal hydronephrosis or hydroureter (abnormal widening of the ureter), as well as reflux in a sibling (routine testing in either circumstance is controversial). Reflux also increases risk of urinary tract infection or acute pyelonephritis, so testing for reflux may be performed after a child has one or more infections.
In infants, the signs and symptoms of a urinary tract infection may include only fever and lethargy, with poor appetite and sometimes foul-smelling urine, while older children typically present with dysuria and frequent urination.
In healthy individuals the ureters enter the urinary bladder obliquely and run submucosally for some distance. This, in addition to the ureter's muscular attachments, helps secure and support them posteriorly. Together these features produce a valvelike effect that occludes the ureteric opening during storage and voiding of urine. In people with VUR, failure of this mechanism occurs, with resultant retrograde flow of urine.
Hardikar syndrome can include Vesicoureteral reflux, hydronephrosis, cleft lip and palate, intestinal obstruction and other symptoms.
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