Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_44
© Springer International Publishing Switzerland 2014
Vesicoureteral Reflux
(1)
Department of Urology, Geisinger Medical Center, 100 N. Academy Av. MC 13-16, Danville, PA 17822, USA
(2)
Department of Pediatric Urology, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 13-16, Danville, PA 17822, USA
Abstract
Vesicoureteral reflux (VUR) is significant in that an incompetent ureterovesical junction (UVJ) allows the retrograde flow of urine from the bladder into the ureter which may result in significant upper urinary tract pathology.
Vesicoureteral reflux (VUR) is significant in that an incompetent ureterovesical junction (UVJ) allows the retrograde flow of urine from the bladder into the ureter which may result in significant upper urinary tract pathology.
1.
Epidemiology:
(a)
Overall incidence: Affects about 1–2 % of the general healthy population.
(b)
Found in up to 50 % of children with history of symptomatic urinary tract infection (UTI).
(c)
Incidence is inversely related with age.
(d)
Affects Caucasian children more commonly.
(e)
Genetics:
(i)
Primary VUR is familial.
(ii)
Autosomal dominant inheritance with variable penetrance.
(iii)
Increased familial prevalence.
1.
32% of siblings of children with VUR.
2.
Affects roughly 2/3 offspring of parents with VUR.
(f)
Gender:
(g)
Male children are affected earlier in life and often with higher grades of VUR.
(h)
Febrile UTI more commonly leads to diagnosis of VUR in female children.
2.
Pathophysiology:
(a)
Primary VUR is related to a congenital anatomic defect within the ureterovesical junction.
(b)
Secondary VUR refers to a separate pathology leading to retrograde flow of urine across the ureter primary due to increased bladder pressures.
1.
Neuropathic bladder dysfunction.
2.
Posterior urethral valves.
3.
Dysfunctional voiding.
4.
Iatrogenic.
3.
Clinical signs:
(a)
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Primarily related to symptomatic UTI or renal failure.
(i)
