UROLOGY CENTRE BENGHAZI , FIFTH YEAR TUTORIAL

1. Vesicoureteral

2. is the retrograde flow of
urine from the bladder
into the upper urinary
tract with or without
dilation of ureters ,renal
pelvis and calyces .
Vesicoureteral
reflux

3. Is that Normal
???Normally Reflux is prevented by :
• low bladder Pressure .
• Efficient ureteric peristalsis .
• The ability of the vesicoureteric
junction to occlude the distal
ureter during bladder
contraction .
• The ureters pass obliquely
through the bladder wall
(intramural part ).

4. VesicouretalReflux
Primary is a defect where the intramural part length is too
short ( ratio < 5:1 )
Secondary
Iatrogenic Following TURP
Functional
Detrusor instability, neurogenic bladder
and Urinary tract infections .
Anatomical Bladder Outlet obstruction

5. Predisposit
ion

6. • Although VUR is more
common in males
antenatally , in later life
there is a definite
female preponderance
with 85% of cases being
female.

7. • VUR has higher predisposition in siblings
ranged from 4.7- 51 % , which is higher than
general population 1 % .

8. • Younger children are more prone to VUR
because of the relative shortness of the sub-
mucosal ureters. This susceptibility decreases
with age as the length of the ureters increases
as the children grow.

10. Clinical presentation
• Asymptomatic , discovered accidently .
• Lower UTI symptoms .
• Fever , chills , loin and abdominal pain, nausea and
vomiting .
• Loin pain associated with a full bladder or
immediately after micturation .
• Recurrent UTI or Loin pain for years .
• Antenatal : Hydronephrosis .
• Renal Failure , Hypertension .

11. Why Reflux is a
Problem ?

12. • Recurrent UTI , Cystitis , Pyelonephritis .
• Hydroureteronephrosis.
• Renal scarring.
• hypertension.
• Renal failure.

13. Investigations :
 Blood :
 CBC : ↑ WBC → Infection .
 ↑ Urea , ↑ Creatinie → Renal Impairment
 Urine analysis : Proteinuria ,
 Radiological :
 Abdominal ultrasound , specially antenatal
,young children .
 Cystography .
 MCUG : Grading
 IVU
 Cytoscopy
 Radionucleotide scanning : DMSA Scanning

15. Management
depends on :Presence & severity of symptoms .
Presence of recurrent infections .
Presence of established renal damage .

16. Recurrent UTI Recurrent UTI Recurrent UTI
No symptoms
between UTI Attacks
less than 3 Years
No symptoms
between UTI Attacks
less than 3 Years.
Constitutional
symptoms :
Acute pyelonephritis
rather than cyctitis
Reflux into non-
functioning Kidney
(<10 % on DMSA ) .
Normal RFT Normal RFT Deteriorated RFT up normal RFT
NO HTN NO HTN HTN
Treat UTI when they
occur , give
prophylactic
antibiotic
Ureteric implantation Ureteric
implantation
Nephroureterectomy
Primary VUR

17. • Treat the underlying cause …
• Patients with no UTI , No high Bladder
pressure → controversial because it’s not
known whether low pressure sterile reflux
cause deterioration over years .
Secondary VUR

18. Thanks for Your

19. Ruwida M. S.Ashour Alorfy