Pediatrics: Vesicoureteral Reflux: Difference between revisions

Line 57:

* '''VUR due to overwhelming the normal function of the UVJ'''

** May be of an anatomic or functional origin in the UVJ, bladder, or bladder outlet

*Reflux is also considered secondary if its absence was documented at some point before its detection.

==== Causes ====

==== Causes (5) ====

*'''Bladder dysfunction'''

#'''Bladder dysfunction'''

**Can be of a congenital, acquired, or behavioral nature

#*Can be of a congenital, acquired, or behavioral nature

**Often the cause of secondary VUR

#*Often the cause of secondary VUR

* '''Posterior urethral valve'''

# '''Posterior urethral valve'''

** '''Most common cause of bladder outlet obstruction in infants'''

#* '''Most common cause of bladder outlet obstruction in infants'''

*** '''In females, anatomic bladder obstruction is rare. The most common structural obstruction in females is from a ureterocele that prolapses into the bladder neck.'''

#** '''In females, anatomic bladder obstruction is rare. The most common structural obstruction in females is from a ureterocele that prolapses into the bladder neck.'''

** Reflux is present in 48-70% of patients with PUV patients

#* Reflux is present in 48-70% of patients with PUV patients

* '''Neurogenic bladder'''

# '''Neurogenic bladder'''

** '''Spina bifida, in particular, is at risk for VUR'''

#* '''Spina bifida, in particular, is at risk for VUR'''

*** '''Special attention for the potential for occult spinal dysraphism is warranted during evaluation of any child with UTI'''

#** '''Special attention for the potential for occult spinal dysraphism is warranted during evaluation of any child with UTI'''

** '''Urodynamic risk factors for VUR:'''

#* '''Urodynamic risk factors for VUR:'''

**# '''Overactivity'''

#*# '''Overactivity'''

**#* '''Most common urodynamic abnormality associated with VUR in neurologically normal children'''

#*#* '''Most common urodynamic abnormality associated with VUR in neurologically normal children'''

**#* Overactive bladder frequently can be responsible for reflux

#*#* Overactive bladder frequently can be responsible for reflux

**# '''Inadequate or obstructive voiding patterns'''

#*# '''Inadequate or obstructive voiding patterns'''

**# '''Higher voiding pressures (may be due to inadequate sphincter relaxation)'''

#*# '''Higher voiding pressures (may be due to inadequate sphincter relaxation)'''

* '''Urinary Tract Infection'''

# '''Urinary Tract Infection'''

** UTIs and their accompanying inflammation can also cause reflux by:

#* UTIs and their accompanying inflammation can also cause reflux by:

**# Lessening compliance

#*# Lessening compliance

**# Elevating intravesical pressures

#*# Elevating intravesical pressures

**# Distorting and weakening the ureterovesical junction

#*# Distorting and weakening the ureterovesical junction

* '''Bladder and bowel dysfunction (BBD)'''

# '''Bladder and bowel dysfunction (BBD)'''

** In older children, acquired abnormalities in bladder and bowel function commonly known as bladder and bowel dysfunction (BBD'')'' have been associated with reflux

#* In older children, acquired abnormalities in bladder and bowel function commonly known as bladder and bowel dysfunction (BBD'')'' have been associated with reflux

*Reflux is also considered secondary if its absence was documented at some point before its detection.

== Grading VUR ==

@@ Line 57: / Line 57: @@
 * '''VUR due to overwhelming the normal function of the UVJ'''
 ** May be of an anatomic or functional origin in the UVJ, bladder, or bladder outlet
+*Reflux is also considered secondary if its absence was documented at some point before its detection.
-==== Causes ====
+==== Causes (5) ====
-*'''Bladder dysfunction'''
+#'''Bladder dysfunction'''
-**Can be of a congenital, acquired, or behavioral nature
+#*Can be of a congenital, acquired, or behavioral nature
-**Often the cause of secondary VUR
+#*Often the cause of secondary VUR
-* '''Posterior urethral valve'''
+# '''Posterior urethral valve'''
-** '''Most common cause of bladder outlet obstruction in infants'''
+#* '''Most common cause of bladder outlet obstruction in infants'''
-*** '''In females, anatomic bladder obstruction is rare. The most common structural obstruction in females is from a ureterocele that prolapses into the bladder neck.'''
+#** '''In females, anatomic bladder obstruction is rare. The most common structural obstruction in females is from a ureterocele that prolapses into the bladder neck.'''
-** Reflux is present in 48-70% of patients with PUV patients
+#* Reflux is present in 48-70% of patients with PUV patients
-* '''Neurogenic bladder'''
+# '''Neurogenic bladder'''
-** '''Spina bifida, in particular, is at risk for VUR'''
+#* '''Spina bifida, in particular, is at risk for VUR'''
-*** '''Special attention for the potential for occult spinal dysraphism is warranted during evaluation of any child with UTI'''
+#** '''Special attention for the potential for occult spinal dysraphism is warranted during evaluation of any child with UTI'''
-** '''Urodynamic risk factors for VUR:'''
+#* '''Urodynamic risk factors for VUR:'''
-**# '''Overactivity'''
+#*# '''Overactivity'''
-**#* '''Most common urodynamic abnormality associated with VUR in neurologically normal children'''
+#*#* '''Most common urodynamic abnormality associated with VUR in neurologically normal children'''
-**#* Overactive bladder frequently can be responsible for reflux
+#*#* Overactive bladder frequently can be responsible for reflux
-**# '''Inadequate or obstructive voiding patterns'''
+#*# '''Inadequate or obstructive voiding patterns'''
-**# '''Higher voiding pressures (may be due to inadequate sphincter relaxation)'''
+#*# '''Higher voiding pressures (may be due to inadequate sphincter relaxation)'''
-* '''Urinary Tract Infection'''
+# '''Urinary Tract Infection'''
-** UTIs and their accompanying inflammation can also cause reflux by:
+#* UTIs and their accompanying inflammation can also cause reflux by:
-**# Lessening compliance
+#*# Lessening compliance
-**# Elevating intravesical pressures
+#*# Elevating intravesical pressures
-**# Distorting and weakening the ureterovesical junction
+#*# Distorting and weakening the ureterovesical junction
-* '''Bladder and bowel dysfunction (BBD)'''
+# '''Bladder and bowel dysfunction (BBD)'''
-** In older children, acquired abnormalities in bladder and bowel function commonly known as bladder and bowel dysfunction (BBD'')'' have been associated with reflux
+#* In older children, acquired abnormalities in bladder and bowel function commonly known as bladder and bowel dysfunction (BBD'')'' have been associated with reflux
-*Reflux is also considered secondary if its absence was documented at some point before its detection.
 == Grading VUR ==