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Vesicoureteral Reflux

  • Michela Cing Yu Wong
  • Girolamo Mattioli
Chapter

Abstract

Vesicoureteral reflux (VUR) is characterised by the backflow of urine from the bladder into the ureter and/or pelvis. It is the most common urological anomaly, affecting 1% of children. It can be primary or secondary to urethral obstruction (e.g. in case of posterior urethral valves—PUVs). If not treated, it could lead to urinary tract infections (UTIs) and nephropathy with high risk of renal damage and/or kidney failure. The percentage of renal failure is very high in the presence of PUVs, condition that is considered life-threatening. The treatment of VUR depends on the aetiology. In primary VUR, antibiotic prophylaxis with watchful waiting is preferred in children <1 year and in those with low-grade reflux as the spontaneous resolution is high. In primary major VUR and in those with recurrent UTIs, the surgical treatment is advised, with endoscopic injection of bulking agents as first-line choice with overall success rate of 85% and negative predictive factor related to the preoperative VUR grade. Ureteral reimplantation success rate is about 95–98%. The most popular surgical technique is Cohen intravesical cross-trigonal reimplantation. In the presence of PUVs, after birth, a bladder drainage is inserted, and after stabilisation of the newborn, valve ablation is performed. In case of worsening of hydronephrosis and creatinine levels despite the bladder drainage, a surgical vesicostomy is advised in order to reduce upper tract pressures.

Keywords

Vesicoureteral reflux VUR PUV Urethral valves Bulking agents Reimplantation Valve ablation 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Michela Cing Yu Wong
    • 1
  • Girolamo Mattioli
    • 1
  1. 1.Paediatric Surgery Unit, Istituto Giannina GasliniDINOGMI University of GenoaGenoaItaly

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