Vesicoureteral reflux, which occurs in one in every 100 children, is the most important and common cause of urinary tract infections in children. While it is more common in girls, it may develop in boys if the urinary tract is closed by a curtain called the posterior urethral valve.
In a normal urinary tract, urine traveling from the kidney to the bladder via the urinary tube ureter never returns from the bladder to the kidney again. If this structure at the junction of the ureter and the bladder is not fully developed at birth, the urine in the bladder may return to the ureter and from there to the kidney. This condition is called vesicoureteral reflux.
In our country, vesicoureteral reflux (VUR) disease is responsible for almost 1/3 of renal failure. Urinary tract infections that develop in the presence of VUR can kill some functioning areas in the kidneys and create non-functioning areas in the kidneys. These areas create images called scars in a special nuclear medicine scan called DMSA.
For this reason, in children who have a febrile urinary tract infection or who have kidney enlargement on ultrasound, a thin catheter should be placed in the bladder and a dye should be injected into it to check whether it leaks back to the kidneys, that is, a voiding cystourethrography should be performed.
Treatment of vesicoureteral reflux includes a wide range of treatments, from long-term low-dose antibiotic administration to endoscopic injection surgery (STING) and open surgery to re-establish the urinary tract junction (ureteroneocystostomy). Treatment varies depending on variables such as the child's age, gender, degree of reflux, whether there is a urination disorder, whether there is kidney damage in DMSA, or whether there are other anatomical disorders.
The treatment must be performed by experienced pediatric urology specialists and detailed information must be given to the mother and father.
Follow-up under antibiotics should be done until the age of 4-5 at most. Reflux that persists after this age requires surgical treatment. The most common treatment method is endoscopically injecting a silicone-like filler into the urinary tract junction. This procedure requires a short anesthesia period and can be performed without blood or catheterization. Endoscopic treatment is the most effective treatment by us. At least 2 sessions are applied, and in unsuccessful cases, open surgery is preferred.
Open surgery may require hospitalization for 1-3 days. Patients may need to have a catheter placed in the urinary tract and remain catheterized for 1-7 days.
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