Vesicoureteral Reflux

Question 1

VUR occurs when

Answer 1

Submucosal tunnel between the mucosa and detrusor muscle at the ureteral attachment to the bladder is short or absent

Question 2

T/F VUR usually is congenital and often is familial

Answer 2

T

Question 3

VUR is graded based on the appearance of the urinary tract on what test

Answer 3

VCUG

Question 4

T/F The higher the VUR grade the greater the likelihood of renal injury

Answer 4

T

Question 5

Observation is the most appropriate management approach for VUR of what grade

Answer 5

I and II, and older children with VUR and normal kidneys who have not experienced clinical pyelonephritis

Question 6

The risk of recurrent UTI is highest in patients with grade ___ reflux

Answer 6

III or IV

Question 7

Antibiotic Prophylaxis in VUR is recommended by the AUA in what population of children (those at greatest risk for VUR-related renal injury)

Answer 7

1) Those younger than 1 yr of age) 2) Children with bowel and bladder dysfunction 3) Children being manage by surveillance and develops a febrile UTI

Question 8

Genetic transmission of VUR

Answer 8

Autosomal dominant

Question 9

The AUA recommended that a VCUG should be performed in neonates with

Answer 9

Grade 3-4 antenatal hydronephrosis (moderate to severe pelvocaliceal dilation), hydroureter, or an abnormal bladder

Question 10

Reflux grades

Answer 10

I: Nondilated ureter, II: Reflux into upper collecting system WITHOUT DILATION, III: Dilated ureter and/or blunting of calyceal fornices, IV: Grossly dilated ureter, V: Tortuosity and loss of papillary impression

Question 11

Reflux is present at birth in ___% of patients with neuropathic bladder

Answer 11

25

Question 12

In siblings of individuals with reflux, a VCUG or cystogram is recommended IF

Answer 12

1) There is evidence of renal cortical abnormalities or renal size asymmetry on sonography 2) The sibling has a history of UTI

Question 13

Reflux occurring during bladder filling

Answer 13

Low-pressure or passive reflux

Question 14

Reflux occurring during voiding

Answer 14

High-pressure or active reflux

Question 15

Used as initial study for reflux

Answer 15

VCUG

Question 16

Used as follow up study for reflux

Answer 16

Radionuclide cystogram scan

Question 17

Mean age of reflux resolution

Answer 17

6 years

Question 18

T/F Reflux does not usually cause renal injury in the absence of infection

Answer 18

T

Question 19

Situtations when reflux can cause significant renal damage even without infection (sterile reflux)

Answer 19

High-pressure reflux: posterior urethral valves, neuropathic bladder, non-neurogenic neurogenic bladder (Hinman syndrome)

Question 20

Surgical therapy for reflux is indicated when

Answer 20

1) Failure of medical therapy 2) high reflux grades that are unlikely to resolve