Vesicoureteral Reflux

Vesicoureteral Reflux evaluation and managementBy Dr Sumit GuptaModerator: Prof. Ak.Kaku.singh

History Vesicoureteral reflux (VUR) represents the retrograde flow of urine from the bladder to the upper urinary tractGalen and da Vinci: - First references to VUR by Western medicine - UVJ as a mediator of unidirectional flow of urine from the kidneys to the bladder

Hutch(1952): Relationship between VUR and chronic pyelonephritis in paraplegic patients Hodson(1959):UTI and renal scarring carried a high likelihood of VUR in children

Demography Prevelance The prevalence of reflux was estimated to be approximately 30% for children with UTI and 17% without infection.Reflux may be present in up to 70%of infants who present with UTI In asymptomatic infants, the prevalence of reflux ranges from 15% in infants with absent or mild hydronephrosis on postnatal ultrasound to 38% in a group of neonates with various postnatal upper tract sonographic anomalies including hydronephrosis, renal cysts, or renal agenesis.

Gender 76% of refluxing infants are male (Ring et al, 1993). In later life, the likelihood of having reflux, presenting with a UTI is higher in male than female.Even though the great majority (85%) of prevailing reflux in older children is in females The reason of high incidence in male is high UTI rate in uncircumcised male

Age Even in the presence of infection or asymptomatic bacteriuria, reflux is more common in younger patients Incidence of Reflux in Patients with Urinary Tract InfectionsAGE (yr) INCIDENCE (%)