Vesicoureteral Reflux
Vesicoureteral Reflux
Structure of Normal urinary tract:
The urinary tract is made up of the kidneys, ureters, bladder and urethra. The kidneys are located high up in the tummy and responsible for filtering waste products from the bloodstream and produce urine continuously. The urine flows down the tubes called ureters from the kidneys to the bladder, which normally stores urine and empties intermittently by muscular contraction. The urine exits the bladder through the urethra in a process is called voiding or urination.
When the ureter joins the bladder it travels through the wall of the bladder for a distance creating a tunnel so that a flap valve is created. This valve prevents back flow of the urine into kidneys when the bladder is full or the child is passing urine. Thus, when the bladder fills and later when it squeezes down to empty, back-up (that is, reflux of urine) is prevented because the valve operates in the same way as when you pinch off a soda straw. This valve-like action is important for several reasons:
➾ prevents bacteria (that often get into the urine) from getting to the kidneys
➾ protects the ureters and kidneys from high pressures generated by the bladder during urination
➾ permits removal of all of the stored urine with a single act of urination, because the bladder urine has nowhere to go other than out the urethra
Diagram of normal urinary tract
Diagram of ureter tunneling through bladder wall
Structure of Normal urinary tract:
The urinary tract is made up of the kidneys, ureters, bladder and urethra. The kidneys are located high up in the tummy and responsible for filtering waste products from the bloodstream and produce urine continuously. The urine flows down the tubes called ureters from the kidneys to the bladder, which normally stores urine and empties intermittently by muscular contraction. The urine exits the bladder through the urethra in a process is called voiding or urination.
When the ureter joins the bladder it travels through the wall of the bladder for a distance creating a tunnel so that a flap valve is created. This valve prevents back flow of the urine into kidneys when the bladder is full or the child is passing urine. Thus, when the bladder fills and later when it squeezes down to empty, back-up (that is, reflux of urine) is prevented because the valve operates in the same way as when you pinch off a soda straw. This valve-like action is important for several reasons:
➾ prevents bacteria (that often get into the urine) from getting to the kidneys
➾ protects the ureters and kidneys from high pressures generated by the bladder during urination
➾ permits removal of all of the stored urine with a single act of urination, because the bladder urine has nowhere to go other than out the urethra
The ureter is shown tunneling through the bladder wall.
1-if the tunneling of the ureter ends here, reflux is likely.
2-if the tunneling of the ureter ends here, reflux is possible.
3-if the tunneling of the ureter ends here, reflux is unlikely.
Secondary reflux: Some children have reflux because of underlying problems such as lower urinary obstruction (such as urethral valves), abnormal bladder behavior (such as uninhibited bladder contractions or hyperreflexic bladders), infrequent voiding, or constipation. IN such children, the primary treatment is towards the underlying disease which led to reflux and generally reflux subsides when the underlying condition is treated.
Normal kidney, ureter, and bladder
Grade I Vesicoureteral Reflux: urine (shown in blue) refluxes part-way up the ureter
Grade II Vesicoureteral Reflux: urine refluxes all the way up the ureter
Grade III Vesicoureteral Reflux: urine refluxes all the way up the ureter with dilatation of the ureter and calyces (part of the kidney where urine collects)
Grade IV Vesicoureteral Reflux: urine refluxes all the way up the ureter with marked dilatation of the ureter and calyces
Grade V Vesicoureteral Reflux: massive reflux of urine up the ureter with marked tortuosity and dilatation of the ureter and calyces
Treatment of VUR
Since many children will outgrow their reflux, the usual plan is to follow up carefully and prevent infections in the interim. Regular tests such as VCUG, renal ultrasound, or nuclear voiding cystogram may be done when required. During this follow-up period they are kept on a prophylactic (low-dose) antibiotic to keep the urine free of infection. Any fever or new urinary tract symptoms (such as burning, frequency, urgency, straining, foul odor, bloody urine, or unusual incontinence) may indicate infection and must be promptly evaluated with urine analysis and urine culture. Children who develop breakthrough urinary infections in spite of antibiotic prophylaxis are at risk for kidney damage and may need surgical correction of reflux.
Surgery for Reflux
Correction of reflux is recommended for high grades of reflux, for reflux that fails to resolve, or for patients with breakthrough infections. Options are:
➾ Endoscopic injections of bulking agents: A small endoscope called cystoscope is placed into bladder and a thick viscous gel called Deflux is injected into the mucosa under the ureteric opening. This leads to creation of a mound which prevents reflux. Advantages include- no cuts, no pain and no post-op complications. Disadvantages are – not 100% successful, can’t be recommended for high grade reflux, gel is expensive and recurrence rate of 10%.
➾ Ureteric re-implantation: Surgical correction of reflux involves recreation of the tunnel and the valve function for the ureteric opening. This can be done via a small incision in the lower part of the tummy or in selected cases laparoscopically. The success rates are more than 95% in properly selected and evaluated patients.
Long term prognosis and follow-up
Children with a history of reflux should probably be monitored life-long with measurement of height and weight, blood pressure, and urine analysis. Occasional ultrasound tests will assure that kidney growth is on target for age and size. If there is any doubt about scarring or kidney function, the pediatric nephrology is also called in to evaluate and manage.
Family members & siblings
If one child in a family has reflux, there is a 20% chance of having reflux in a sister or brother. Because we know that the chances of kidney damage are highest in the first 6 years of life, we think that brothers and sisters in that age range should be studied (with examination and atleast an ultrasound). Also if there is any symptoms suggestive of urinary infection, a VCUG should be done.
Testimonials
Real reviews from our patients on Google
Kranti Tandel
2 months ago
From the moment I walked into the hospital until the day I was discharged, I felt genuinely cared for.
A heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Read moreA heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Shilpa Nair
4 months ago
I had an excellent experience and am very grateful for the care and support I received. The entire staff was professional, friendly, and attentive, making me feel comfortable throughout the process.
A special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Read moreA special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Mahendra Patil
4 months ago
My 3 years 11 month year old daughter was diagnosed with 10 mm kidney stone Dr.A.k.Singhal,Dr.Manish Dubey,and Dr.Ashwita Shenoy performed the surgery to remove the stone on May 30th with immense success. I am deeply grateful for the exceptional care and professionalism demonstrated by this entire team.
From the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Read moreFrom the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Purva Shingare
4 months ago
Had kidney stone surgery done by Dr Manish Dubey. All staff was cooperative. Doctor Dubey made me so much relaxed that I was not at all worried about the procedure. Other doctors in the OT were also very sweet. The staff is very nice, hospital is clean ,no smell of medicines, housekeeping services are very good. Hospital food is also very nice,tasty and healthy. Insurance procedure is also very easy. The surgery procedure went so smoothly. I would surely recommend Mitr Hospital and special thanks to Dr Dubey.
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Nikita Ghodke
6 months ago
I had an amazing experience at the hospital, which offers excellent facilities and truly stands out in terms of care and support. I was under the treatment of Dr. Vijaykumar Yadav, who is exceptional in his field. His kindness, compassion, and dedication to his work made a significant difference throughout my journey.
He is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Read moreHe is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Dimple Choudhary
1 year ago
Very polite staff N great service ☺️
Ketan Bhagat
1 year ago
Excellent,
We had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Read moreWe had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Pankaj Choudhary
1 year ago
Very experienced Doctor and cooperative staff. They give full time to patients for there Query and problems.
Blood test Camp organised for Woman's day was support and very helpful
Read moreBlood test Camp organised for Woman's day was support and very helpful
Sneha Omale
1 year ago
डॉ. अमित घरत इंडॉस्कॉपी खूप छान पध्दती ने केली . धन्यवाद डॉक्टर आणि त्यांची टीम . वेळोवेळी मदत केली बद्दल.
prathamesh palkar
1 year ago
“I am extremely grateful for the excellent service provided by Mr.Aditya Sir from the hospital TPA insurance team. He was incredibly professional, patient, and thorough in explaining my insurance coverage and guiding me through the entire process. His prompt assistance and dedication made everything smooth and hassle-free. I truly appreciate his kindness and efficiency in handling my queries. Thank you, Aditya Sir, for your outstanding support!”
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