VU reflux

Question 1

What is VUR?

Answer 1

Developmental anomaly fo VU junction

Ureters displaced laterally enter directly into the bladder rather than at an angle
Therefore shortened intramural course of ureter
Junction cannot therefore function adequately

Abnormal backflow or urine from bladder into ureter and kidney

Question 2

What is grade I VUR?

Answer 2

Reflux into the ureter only, no dilatation

Question 3

Grade II VUR?

Answer 3

Reflux into he renal pelvis on micturition, no dilatation

Question 4

Grade III VUR?

Answer 4

Mild/moderate dilatation the ureter, renal pelvis and calyces

Question 5

Grade IV VUR?

Answer 5

Dilatation of the renal pelvis and calyces with moderate ureteral tortuosity

Question 6

Grade V VUR?

Answer 6

Gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity

Predisposes to infrarenal reflux and renal scarring

Question 7

What are causes of VUR?

Answer 7

Familial
Secondary to bladder pathology
Can occur with UTI (temporary)

Question 8

Why is VUR-associated ureteric dilatation important?

Answer 8

Urine returning to the bladder from he ureters after voiding results in incomplete bladder emptying which encourages infection
Kidneys may become infected (pyelonephritis)
Bladder voiding pressure is transmitted to the renal papillae which may contribute to renal damage
Infection may destroy renal tissue leaving a scar, resulting in shrunken poorly functioning kidney
CKD may develop if scarring is severe

Question 9

What investigation for VUR?

Answer 9

Following first UTI:
USS identifies:
Serious structural abnormalities and urinary obstruction
Renal defects

If US abnormal:

Micturating Cystourethrogram
DMSA scan may be performed for renal scarring

Question 10

Management?

Answer 10

Goal is to minimise infection as it is infection that cause scarring not VUR
Prophylactic ABX:
Amoxicillin/ampicillin in <6w
Trimethoprim-sulfamethoxazole co-trimoxazole 6w-2m
Nitrofurantoin >2m
Bowel and bladder management