VUR Flashcards
Q: What is Vesicoureteric Reflux (VUR)?
A: VUR is the abnormal retrograde flow of urine from the bladder into the upper urinary tract, with or without dilatation of the ureter, renal pelvis, and calyces. It can lead to renal failure (reflux nephropathy).
Q: What is the epidemiology of VUR?
A: VUR has an incidence of over 10% in children, is more common in younger children and girls (female-to-male ratio of 5:1), and is more prevalent in Caucasians. Siblings of affected children have a 40% risk of reflux.
Q: What is the pathophysiology of VUR?
A: Normally, reflux is prevented by low bladder pressure, efficient ureteric peristalsis, and the vesicoureteric junction (VUJ) occluding the distal ureter during bladder contraction. The ureters pass obliquely through the bladder wall (intramural ureter), and as the bladder grows, VUR tends to resolve spontaneously.
Q: What are the classifications of VUR?
A:
1. Primary VUR: A defect in the intramural length of the ureter.
2. Secondary VUR: Due to bladder outlet obstruction (e.g., BPH, urethral stricture), poor bladder compliance (e.g., spina bifida), iatrogenic causes (e.g., post-TURP, radiotherapy), and inflammatory conditions (e.g., UTI).
Q: What are the associated disorders with VUR?
A: VUR is commonly seen in duplex ureters and can be exacerbated by cystitis. Coexisting UTI with VUR can lead to pyelonephritis, reflux nephropathy, renal scarring, hypertension, and renal impairment.
Q: What are the common presentations of VUR?
A:
- Symptomless, often identified incidentally on VCUG or ultrasound.
- Symptoms of UTI or loin pain, particularly after micturition.
Q: What is the definitive test for diagnosing VUR?
A: The definitive test is cystography, either during bladder filling or voiding (voiding cystourethrography or VCUG). Urodynamics is used to assess voiding dysfunction if clinically suspected.
Q: How is VUR graded?
A: VUR is graded based on the radiographic appearance of the calyces on VCUG. Grades I-V represent increasing severity, with Grade V being the most severe.
Q: What is the general management approach for VUR?
A: VUR often resolves spontaneously, particularly in younger children. Management can be medical (antibiotic prophylaxis, regular monitoring) or surgical (for higher grades or complications).
Q: What are the medical management options for VUR?
A :
- Continuous low-dose antibiotic prophylaxis.
- Regular urine cultures and yearly cystograms.
- Ampicillin or amoxicillin for infants younger than 6 weeks, and trimethoprim & sulfamethoxazole after 6 weeks.
Q: What are the indications for surgical intervention in VUR?
A:
- Breakthrough infections despite antibiotics.
- Poor compliance with medical management.
- Progressive renal scarring.
- Severe reflux (Grade IV or V).
- VUR that persists after puberty.
Q: What are the surgical techniques for VUR correction?
A:
- Intravesical methods: Cohen repair, Politano & Leadbetter repair.
- Extravesical techniques: Lich & Gregoir procedure.
- Endoscopic subtrigonal injections for ureteric orifice correction.
- Nephroureterectomy for non-functioning kidneys with recurrent UTIs.
