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Reflux into the ureter
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- The abnormal flow of urine from the bladder, upstream into one or both ureters and thence into the kidneys.
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- Symptoms of bladder infection
- Incontinence of urine
- Signs of Pyelonephritis or dilation of the urinary tract on X-ray, ultrasound, or other imaging studies
- Signs of renal insufficiency (poorly functioning kidneys): high blood pressure, anemia (low red blood cell count), heart enlargement, edema or fluid overload in the tissues, blood in the urine, protein in the urine, decreased amounts of urine
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- Reflux can be primary or secondary.
- Primary reflux usually means there is a partial or complete anatomic obstruction to the outflow of urine, causing some of the urine to flow upstream. Common sites of obstruction in the urinary tract are:
- At the UP junction (where the urine collecting system at the kidney pelvis joins the ureter)
- At the UV junction (where the ureter joins the bladder
- In the vicinity of the bladder outlet or in the urethra. See the chapter on posterior urethral valves. Vesicoureteral reflux would refer to sites ( 2 ), ( 3 ), or any obstruction within the bladder.
- Secondary reflux means that the child was born without obstruction in the urinary tract, but later developed a cause for reflux.
- When partial or complete obstruction to urine flow develops, urine buildup leads to a dilated sac of tissue behind the obstruction, and the blocked urine can develop a backflow upstream, which is the reflux.
- The urine will flow along the path of least resistance, which might be upstream, in the case of obstruction.
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- Diagnosis is suspected in children after a bacterial cystitis (bacterial infection of the bladder) because reflux commonly occurs during and immediately after bacterial cystitis in children. Frequently, reflux disappears shortly after the bacterial infection resolves.
- Reflux may persist. It can be demonstrated by the upstream flow of dye, which is injected into the bladder and flows up the ureter(s) on sequential X-ray views.
- The flow study commonly used to demonstrate this reflux is an X-ray study called VCUG (voiding cystourethrogram).
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- Posterior urethral valves
- Anatomic narrowing in the urinary tract
- Urinary Tract Infection
- Bladder stones
- Bladder spasm or bladder sphincter spasm
- High pressure in the bladder, from external compression (for example, compression by a large volume of hard stool in the rectum)
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- Treatment of underlying infection, if any
- Possible surgical treatment:
- Correction of posterior urethral valves
- Tapering and re-implantation of the ureter or ureters if the ureters have dilated and their insertion into the bladder wall is abnormal
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- If the child is old enough to express himself and is over the age of 3 or 4, he/she may describe symptoms that go along with reflux, which are:
- Symptoms of a bladder infection (i.e., pain over the bladder, a feeling that the bladder is bulging, hesitancy to make urine, having to make urine too often, pain while urinating, back pain, fever, cloudy or smelly urine)
- Incontinence of urine (wetting oneself frequently) even though toilet trained
- A symptom that is understandably a result of reflux: the child empties the bladder completely of urine, and then 5 minutes later, finds that there is a lot more urine in the bladder, and has to "go again"
- This is a reflux symptom because the bladder squeezes some urine out the urethra and squeezes some urine up the ureters at the same time. After a few minutes, the urine high in the ureters dribbles down into the bladder again, and the child has to "go again."
- Discuss any reflux symptoms with your physician, since reflux might mean a defect in the anatomy of the urinary tract, or a reason for having urine infections repeatedly.
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