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Paediatrics > Vesicoureteric Reflux > Flashcards

Vesicoureteric Reflux Flashcards

1
Q

What is vesicoureteric reflux (VUR)?

A

The retrograde flow of urine from the bladder into the upper urinary tract

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2
Q

What causes VUR?

A

When the ureters are displace laterally and enter directly into the bladder rather than at an angle, with a shortened or absent intramural course

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3
Q

What can severe cases of VUR be associated with?

A

Renal dysplasia

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4
Q

Is all VUR the same?

A

No, a spectrum of severity

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5
Q

What happens in more mild VUR?

A

There is reflux into the lower end of an undilated ureter during micturition

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6
Q

What happens in the most severe form of VUR?

A

Reflux during bladder filling and voiding with a distended ureter, renal pelvis and clubbed calyces

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7
Q

Is mild reflux always significant?

A

No

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8
Q

What can happen with more severe VUR?

A
  • Intrarenal reflux
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9
Q

What is intrarenal reflux?

A

Backflow of the urine from the renal pelvis into the papillary connecting ducts

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10
Q

What is intrarenal reflux associated with?

A

High risk of renal scarring if UTI’s occur

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11
Q

Of what origin is VUR most commonly?

A

Congenital

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12
Q

When might VUR be acquired?

A

Post-surgery

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13
Q

What other bladder pathologies might VUR occur with?

A
  • Neuropathic bladder
  • Urethral obstruction
  • After UTI (temporary)
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14
Q

What are the clinical features of VUR?

A

There are no specific clinical features of VUR

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15
Q

How is VUR identified?

A

It is identified by investigation after atypical UTIs or recurrent UTIs

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16
Q

On what basis is VUR graded?

A

The extent of retrograde reflux from the bladder

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17
Q

What is grade I VUR?

A

Into ureter only

18
Q

What is grade II VUR?

A

Into ureter, pelvis, and calcyes with no dilation

19
Q

What is grade III VUR?

A

With mild/moderate dilatation, slight or no blunting of fornices

20
Q

What is grade IV VUR?

A

Moderate dilation of ureter and/or renal pelvis, and/or tortuosity of ureter, and obliteration of sharp angle of fornices

21
Q

What is grade V VUR?

A

Gross dilation, tortusity, no papillary impression visible in calyces

22
Q

What is a diagnosis of VUR made on the basis of?

A

A micturating cystourethrogram (MCUG)

23
Q

What does a MCUG involve?

A

Urinary catheterisation, and the administration of radiocontrast medium into the bladder

24
Q

When is reflux detected in MCUG?

A

On voiding

25
Q

What is good about MCUG?

A

You can see the grade of reflux

26
Q

What is bad about MCUG?

A
  • Requires catheterisation

- Give radiation dose

27
Q

What are the differential diagnoses of VUR?

A
  • Antenatal hydronephrosis
  • Neurogenic bladder dysfunction
  • Posterior urethral valves
  • Ureterovesical obstruction
28
Q

What is the aim of management of VUR?

A

Prevent infection

29
Q

Why is it important to prevent infection in VUR?

A

To prevent renal scarring

30
Q

What does the medical management of VUR involve?

A

Prophylactic antibiotics

31
Q

Is surgery routinely recommended in VUR?

A

No

32
Q

What are the indications for surgery in VUR?

A
  • Failed medical therapy

- Poor compliance

33
Q

What are the surgical options for the management of VUR?

A
  • STING procedure
  • Endoscopic injection of maternal behind ureter
  • Open surgery with re-implantation of ureters
34
Q

What is a STING procedure?

A

Subureteric Teflon injection

35
Q

What is the purpose of endoscopic injection of material behind the ureter?

A

To provide a valve mechanism during bladder filling and emptying

36
Q

What imaging methods are sometimes used for follow-up of VUR?

A

Indirect cystogram and DMSA

37
Q

What are the potential complications of VUR?

A
  • Renal scarring
  • VUR associated ureteric dilation
  • UTI
  • Renal damage
38
Q

What is another term for the renal scarring seen due to VUR?

A

Reflux nephropathy

39
Q

What happens in reflux nephropathy?

A

Untreated UTI’s lead to permanent damage to the kidney tissue

40
Q

What can extensive renal scarring lead to?

A

High blood pressure and kidney failure

Paediatrics (115 decks)

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