Vesicorenal reflux (VRR) refers to the abnormal backing up of urine in the ureter to the kidney. The increased pressure in the kidney can cause lasting damage. Urinary reflux can be congenital.
Here you will find further information as well as selected specialists and centers for vesicorenal reflux.
In medicine, vesicorenal reflux (VRR) is also known as vesicoureteral reflux (VUR). This refers to the backflow of urine from the bladder into the ureter. Urine reflux can lead to the renal pelvis.
The urine can exert too much pressure at these points over a longer period of time. There is then a risk of kidney damage. In addition, the penetration of bacteria can lead to painful kidney inflammation. This can lead to scarring in the kidney tissue.
Doctors differentiate between the primary and secondary forms of vesicorenal reflux. While the primary form is congenital, the secondary form is acquired in the course of life.
A distinction is also made between a low-pressure VRR and a high-pressure VRR:
Vesicorenal reflux has different manifestations. An important criterion for this is the extent to which the anatomical structures are altered by the pressure of the urine. A typical pressure-related change is the widening (technically: dilatation)
Since 1985, vesicorenal reflux has been classified into five different degrees of severity (according to Parkkulainen/Heikel):
Normally, urine flows out of the kidney via the two ureters to the bladder. The end of the ureter at the bladder serves as a valve that ensures that the urine does not flow back to the kidneys.
However, a disruption of this function is sometimes congenital. This is due to malpositioning of the ureteral orifice in the wall of the bladder. In most cases, the intramural course of the ureter is then too short. If the pressure in the bladder increases, the upper urinary tract cannot be properly sealed as a result.
Secondary vesicorenal reflux is caused by direct impairment of the ureteral orifice. This can be triggered by urinary bladder inflammation or neurogenic bladder dysfunction.
In some cases, overstretching of the bladder wall is also responsible for the development of vesicorenal reflux.
In vesicorenal reflux, urine backs up to the kidneys and damages them © rumruay | AdobeStock
Babies and young children with vesicorenal reflux usually suffer from
In older children and adult patients there are
The backing up of urine increases the risk of urinary tract infections. Harmful germs can reach the renal pelvis. The resulting inflammation of the kidneys can lead to scarring of the kidney tissue. This condition is called reflux nephropathy.
As vesicorenal reflux progresses, patients suffer from secondary symptoms such as
Incontinence can occur as early as childhood. In the less serious cases, however, vesicorenal reflux in children often heals spontaneously.
If vesicorenal reflux is suspected, the examination should be carried out by a specialist in urology or pediatric urology. The first step in the examination is to take the patient's medicalhistory.
The doctor will ask about the patient's symptoms and any previous illnesses.
Further indications may include
can provide further information. Possible damage can be detected in this way.
Another diagnostic tool is sonography (ultrasound examination). The urologist can use this method to determine whether the ureters or renal pelvis are dilated.
A micturating cysto-urethrogram is used to assess the severity of vesicorenal reflux. In this examination, contrast medium is filled into the bladder via a thin catheter.
X-ray fluoroscopy (or sonographic imaging if necessary) can be used to visualize the reflux of the contrast medium into the ureter or renal pelvis during filling or urination if reflux is present.
In addition
can be assessed.
Following an MCU, the doctor can in some cases perform a cystoscopy. In this way, the shape, circumference and position of the ureteral orifices can be determined.
At the same time, the reflux can be treated during the same procedure (reflux injection).
A kidney scintigraphy is also considered useful in some cases. This is one of the nuclear medicine examination procedures. This examination is used to detect scars on the kidney tissue following previous inflammation.
The treatment of VRR depends on the severity of the disease.
If it is only a mild form, the administration of antibiotic medication is sufficient.
This can effectively combat the urinary tract infection and prevent new infections. There is a good chance that the reflux will disappear with age, so to speak.
An endoscopic injection has the effect of
Dextranomer/hyaluronic acid (deflux) is injected under the ureteral orifice into the bladder via cystoscopy. The injection takes place under anesthesia.
The lower the degree of reflux, the greater the chance of long-term success.
Open surgical therapy is the most successful treatment for reflux, accounting for around 95 percent of cases. It is mainly used for severe reflux or if the injection method fails.
The most commonly used technique is Lich-Gregoir anti-reflux plastic surgery. It extends the course of the ureter through the bladder wall by forming a muscular tunnel. The bladder does not need to be opened - the operation is performed through a small incision in the lower abdomen.
An operation should always be performed if
An annual ultrasound examination of the kidney is important, both after endoscopic injection and after open reflux correction. This allows kidney growth to be monitored up to puberty and a renewed urinary transport disorder to be ruled out.
Immediately after the procedures, check-ups (urine tests, ultrasound, blood pressure checks) should be carried out more closely.
If vesicorenal reflux is already congenital, there are no preventive measures. In the secondary form, urologists recommend emptying the bladder in two stages. This means that after the first voiding, there is a break of a few minutes until the next voiding.
Even without treatment, vesicorenal reflux often heals again. In some cases, however, serious complications are possible, so it is always advisable to consult a doctor.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
