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Urology
Vesicoureteral Reflux
Urine normally travels from the kidney to the bladder in one direction like cars on a one-way street. Reflux is the retrograde, or backwards, flow of urine from the bladder into the ureter and kidney. Approximately 20 percent of children with hydronephrosis will have reflux. A voiding cystourethrogram (VCUG) test establishes the diagnosis of reflux. The VCUG involves placing a small catheter into the bladder via the urethra. The bladder is then filled with a dye material (contrast) and the bladder is inspected with quick X-ray snapshots (fluoroscopy) to see if the dye stays in the bladder during filling and voiding or if it escapes to the kidney.
When reflux is present, it is graded 1 through 5. Most children who have reflux have grades 1 through 3 and most of these resolve in the first few years of life.
The main goal of treatment is prevention of urinary tract infection (UTI). UTI combined with reflux can cause kidney infections (pyelonephritis) and possibly even kidney damage. If reflux requires surgical treatment, the options include ureteral reimplantation or cystoscopic injection of a material into the ureteral orifice. The success rate of ureteral reimplantation is in the range of 98 percent in most cases. The ureter is brought further into the bladder. This allows the ureter to become compressed during bladder filling, which prevents reflux. Success for the bladder injections can range from 50 to 85 percent with the more severe grades of reflux having the lower rates of success.
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