Does your child have frequent urinary tract infections? There is a risk that this is due to the presence of vesicoureteral reflux. Find out more about this urinary system defect.
What prevents urine from flowing back from the bladder into the ureter?
Urine, which is produced in the kidneys, should flow through the ureter into the bladder and from there through the urethra be excreted out. There is a special valve in the place where the ureter meets the bladder. Its role is to pass the urine in only one direction: from the ureter to the bladder. This prevents urine from flowing back into the ureter and on to the kidney. For this mechanism to work efficiently, the ureter penetrates the bladder wall and runs along a sufficiently long section and at the right angle. This is called submucosal segment of the ureter. When the bladder is filled with urine, the bladder, contracting, squeezes the opening of the ureter. Thus, it allows urine to pass and, at the same time, closes the path of its return to the ureter.
Why does reflux occur?
Vesicoureteral reflux disease occurs mainly in children and is the most common urinary tract disease in this age group. There are primary and secondary reflux.
Primary reflux this is as much as 70% of cases – it occurs when the valve mechanism, i.e. the connection of the ureter with the bladder, is abnormal. This happens when, for example, the ureter enters the bladder wall at the wrong angle, or its submucosal section is too short,
Secondary reflux occurs less frequently. It is related to the existence of an obstruction below the ureteral openings to the bladder. This occurs, for example, in the case of prostate enlargement, narrowing of the opening of the urethra in girls, presence of the posterior urethral valve in boys, damage to the urinary bladder innervation – the so-called neurogenic bladder. In these cases, the pressure in the bladder increases and urine flows back into the ureter.
Urinary tract infection is the main symptom of reflux
Vesicoureteral reflux causes urine to stagnate, which is a very good breeding ground for bacteria. Urinary tract infection develops, which is the main reason for starting the diagnosis of vesicoureteral reflux.
A child with reflux often has a problem with bedwetting, it may have stomach ache, it is sometimes lethargic and has no appetite. And during urinary tract infections, he can develop a fever.
Diagnostics
The occurrence of urinary tract infection in children (in boys after the first episode of infection) requires extended diagnostics. A urine test, an abdominal ultrasound scan, and a test called voiding cystourethrography are performed. It consists in inserting a catheter into the bladder and filling it with fluid with a contrast agent. And then taking X-rays during micturition (urination). This test allows not only to detect reflux, but also to determine its degree (i.e. the amount to which urine reflux). Sometimes the diagnostics may be extended to include other tests, such as kidney scintigraphy.
Treatment
Treatment depends on the frequency of urinary tract infections and the severity of the reflux, which is determined by voiding cystography. Low-grade reflux is not a medical problem. Treatment of infections is carried out by administering an antibiotic and prophylaxis of infections (antibiotic in a lower dose). A higher degree of reflux and secondary reflux may require surgery and the care of a nephrologist.
How can urinary tract infections be prevented?
– do a urine check up,
– drink a lot,
– take care of the hygiene of intimate parts of the body, wash in the morning and during the day,
– avoid long baths in the bathtub,
– make sure your bladder is completely empty during micturition,
– dried cranberries can be taken as a preventive measure.
Why is the treatment of vesicoureteral reflux so important?
This disease can lead to abnormal development of the child as well as kidney disease and the associated high blood pressure.
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