(NEPHRITIS) by introducing into the kidneys BACTE-
RIA that may be present in the urine. Vesi-
coureteral reflux also can cause HYDRONEPHROSIS,
dilation of the renal pelvis that results from the
accumulation of urine. Nephritis and hydro-
nephrosis both can cause permanent and some-
times progressive kidney damage.
Symptoms and Diagnostic Path
The most common indication of vesicoureteral
reflux is infection, the symptoms of which typi-
cally include
- flank or ABDOMINAL PAIN
- FEVERand chills
- HEMATURIA(BLOODin the urine) or cloudy urine
- DYSURIA(discomfort with URINATION)
- urinary frequency and urinary urgency
As well, the person may strain when urinating
and feel as though urine remains in the bladder
(URINARY RETENTION) after urinating. The diagnostic
path begins with urinalysis, which shows the pres-
ence of bacteria, leukocytes (white blood cells that
fight infection), and erythrocytes (red blood cells)
when there is an infection. The urologist may per-
form diagnostic imaging procedures, such as
abdominal ULTRASOUND or COMPUTED TOMOGRAPHY
(CT) SCAN, to visualize the structures of the urinary
system and identify any anomalies. Radionuclide
scan, INTRAVENOUS PYELOGRAM (IVP), and voiding
CYSTOURETHROGRAMare additional diagnostic proce-
dures that help the urologist assess the urinary
system’s structure and function. Diagnosis of vesi-
coureteral reflux includes the designation of
grade, which denotes the severity of the urine
reflux and the effect on the kidneys.Treatment Options and Outlook
Infection requires immediate treatment with
ANTIBIOTIC MEDICATIONS. When the vesicoureteral
reflux occurs secondary to an obstructive condi-
tion, treatment targets the underlying cause as
well as any consequential infection. Treatment for
primary vesicoureteral reflux depends on the per-
son’s age and the grade of the reflux. Children are
likely to outgrow grade 1 and grade 2 reflux when
the cause is short ureters and often when the
cause is unusual entry of the ureters into the blad-
der. Grade 3 reflux may require corrective surgery.
Grade 4 and grade 5 refluxes require reconstruc-
tive surgery such as ureteroneocystostomy, in
which the surgeon creates new insertion tunnels
into the bladder for the ureters. Appropriate treat-
ment reduces the risk for permanent damage to
the kidneys and restores the normal flow of urine.Risk Factors and Preventive Measures
In children the primary risk factors for vesi-
coureteral reflux are anomalies of structure within
the urinary system; these are not preventable. In
adults risk factors for vesicoureteral reflux include
NEPHROLITHIASIS (kidney stones), urolithiasis,
chronic URINARY TRACT INFECTION(UTI), and BENIGN
PROSTATIC HYPERPLASIA(BPH) in men. Prompt and
appropriate treatment for these conditions reduces
the risk they will cause vesicoureteral reflux.
See alsoBLADDER EXSTROPHY; CONGENITAL ANOM-
ALY; SURGERY BENEFIT AND RISK ASSESSMENT.230 The Urinary System