What is Vesicoureteral Reflux (VUR) in Children?
Vesicoureteral reflux (VUR) is a medical condition characterized by the abnormal backward flow of urine from the urinary bladder up to the kidneys. In normal anatomy, the ureters enter the bladder at an angle that creates a one-way valve mechanism. Insufficiency of this mechanism or high pressure in the urinary tract causes urine to flow back, potentially leading to permanent kidney damage (scarring) over time.
Symptoms and Diagnosis of VUR
VUR typically presents with recurrent urinary tract infections (UTIs). Especially infections accompanied by high fever indicate kidney involvement (pyelonephritis). The primary diagnostic methods include:
- Ultrasonography (USG): The initial step to assess kidney size, dilation (hydronephrosis), and parenchymal quality.
- Voiding Cystourethrogram (VCUG): Known as the contrast voiding cystogram, this is the gold standard for definitive diagnosis and grading (Grades 1-5) of reflux.
- DMSA Renal Scintigraphy: Used to detect permanent kidney scars and evaluate the functional contribution of each kidney.
VUR Surgery and Treatment Options
Treatment for VUR is planned based on the child's age, the grade of reflux, the presence of kidney damage, and the frequency of recurrent infections. Low-grade reflux (Grades 1-3) often resolves spontaneously as the child grows and is managed with prophylactic antibiotics. However, high-grade reflux (Grades 4-5) or cases with progressive kidney damage during follow-up require surgical intervention.
1. Endoscopic VUR Injection (Minimally Invasive Surgery)
This is currently the most preferred minimally invasive method. Using a cystoscope (a camera-equipped instrument) inserted through the urethra, a special bulking agent is injected beneath the ureteral orifices. This creates a barrier that prevents urine backflow. No external incision is made, hospital stay is minimal, and success rates are high.
2. Open and Laparoscopic Ureteral Reimplantation
In cases where endoscopic treatment fails or anatomical abnormalities are severe, the angle at which the ureters enter the bladder is surgically reconstructed. This surgery can be performed via open, laparoscopic, or robotic approaches, boasting a success rate of over 95%.
VUR Treatment and Surgical Process in Adana
Adana offers advanced diagnostic and therapeutic infrastructure in the field of pediatric urology. Pediatric urologists in the region successfully perform VUR surgeries using modern endoscopic injection systems and micro-surgical techniques. Before surgery, the child's urine culture must be sterile, and the procedure is performed under general anesthesia. Postoperative care includes regular ultrasound monitoring and follow-up imaging to ensure kidney health.