Vesico-ureteric reflux (VUR) is the retrograde flow of urine from the bladder up into the kidney. VUR may be mild, self-limiting, asymptomatic and of no future significance – or may be severe and associated with malformed (“dysplastic”) or scarred kidneys and/ or febrile urine infections. VUR is classified as “low-grade” (Grades 1-2 on cystogram (see below), ie not associated with swelling or dilatation of the kidney and ureter) or “high-grade” (Grades 3-5, associated with dilatation of both kidney and ureter). Low-grade VUR is of no consequence and does not require antibiotic treatment or further investigation. High-grade VUR is best treated by a paediatric urologist or nephrologist as it may be associated with reduced function or scarring of the associated kidney, as well as abnormalities such as duplex (double) kidneys and out-pouchings of the bladder called diverticula. These kidney abnormalities are congenital (from birth) and may run in families. Kidney scarring may be made worse by recurrent febrile infections. Hence appropriate monitoring and treatment is important.
VUR may be suspected on ultrasound but needs further tests for confirmation. The best test for VUR is a micturating cystogram (MCUG). However, this is a specialised test which involves insertion of a small soft tube into the bladder, and itself carries a risk of urine infection – therefore must only be advised selectively as advised by a specialist. Your specialist will increase the baby’s antibiotic cover for three days starting the day before the procedure (NICE guidelines). A less sensitive test called a MAG-3 cystogram or indirect MAG-3 may also be used to look for VUR in toilet-trained children.
VUR without symptoms (infection) is initially treated with a daily low-dose of antibiotic (usually Trimethoprim at a quarter of the normal dose, so it does not affect the baby’s immunity or growth in any way). The antibiotic protects the baby from infection until the VUR self-resolves. If the child gets “break-through” infections in-spite of the daily antibiotic, then a simple procedure called a “Deflux injection” may be performed to stop or reduce the VUR.
Deflux is a biodegradable paste (Dextranomer-Hyaluronic acid compound) which may be injected into the ureteric orifice (the place where the kidney ureter opens into the bladder) in order to reduce the back-flow of urine into the kidney. The paste is injected via a cystoscope, a fine delicate telescope that is inserted into the bladder via the urethra (wee tube) under general anaesthetic. Therefore no cuts or open surgery are involved. The procedure takes about ten minutes and the child can usually go home the same day. Success rates depend on the Grade of VUR and the associated kidney anomalies, but your paediatric urologist will advise accordingly. If the first procedure is not successful, the injection may be safely repeated a second time. The risk of blocking the ureter is small (<1%).
Please visit your GP and request a referral to Chelsea & Westminster Hospital Paediatric Urology
Miss MK Farrugia
Please e-mail [email protected] or book an appointment in Chelsea & Westminster Hospital (0203-315-8599) or BUPA Cromwell Hospital (0207-460-5700)