It is the reflux of urine from the bladder to the ureter together with the contraction of the bladder during voiding due to insufficiency of the ureterovesical junction.
The incidence in asymptomatic children is below 0.5% (five per thousand). It may resolve spontaneously, but its presence is always considered abnormal.
About 30-50% of children with urinary tract infections have VUR. This rate decreases with age.
Urine reflux may occur up to the kidney parenchyma in VUR, and if bacteria are present in the urine, it may lead to acute pyelonephritis. With or without an infection, VUR can cause reflux nephropathy, disrupt the normal development of the kidney, and cause hypertension.
Almost all children with severe scarring in their kidneys have VUR. Reflux scarring is most common in the polar regions. In the development of severe scarring, hypertension and even kidney failure may develop in the later stages. Especially in the first 1 year of age, the possibility of scar development as a result of intrarenal reflux is higher. Urinary tract infections occurring after this age do not cause a significant scar development in the kidneys.
Any finding may not be detected without advanced reflux on ultrasound examination. In the presence of reflux at a level that fills the ureter and reaches the intrarenal collecting system and expands the collecting system, the degree of enlargement in ultrasound examination, whether it causes thinning of the kidney parenchyma, and the level of ureteral enlargement can be evaluated. In a few cases in children who have not yet acquired toilet habits, the presence of reflux can also be seen directly if they urinate during the examination of the bladder with ultrasound. In addition, a change in the width of the collecting system during the examination is a finding that can be interpreted in favor of reflux.
The following radiological algorithm can be followed in children with urinary tract infection:
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Pyelonephritis and Those with normal ultrasound findings: Voiding cystourethrography
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Under 3 years of age, urinary tract infection: Voiding cystourethrography or radionuclide cystography
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3 -Over 4 years old, has urinary tract infection but no signs of pyelonephritis and ultrasound is normal: Radionuclide cystography if desired
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Lower urinary tract infection (cystitis or urethritis) and ultrasound is normal: No need for additional radiological examination.
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There is lower urinary tract infection (cystitis or urethritis) and ultrasound is abnormal: Voiding cystourethrography or radionuclide cystography
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For screening purposes in patients with severe family history of VUR: Radionuclide cystography.
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For follow-up purposes in patients with VUR: Radionuclide cystography.
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