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[Vesicoureteral reflux and urinary tract infections]

Małgorzata Baka-Ostrowska1

  • 1Klinika Urologii Dzieciecej Instytutu Pomnik-Centrum Zdrowia Dziecka w Warszawie. m.baka@czd.pl

Polski Merkuriusz Lekarski : Organ Polskiego Towarzystwa Lekarskiego
|October 18, 2008
PubMed

Insights

Vesicoureteral reflux (VUR) in children is caused by voiding dysfunction, not urinary tract infections (UTI). Treating bladder dysfunction is key to managing VUR and preventing recurrent febrile UTIs.

Area of Science:

  • Pediatric Urology
  • Urodynamics
  • Pediatric Nephrology

Context:

  • Vesicoureteral reflux (VUR) and urinary tract infections (UTI) in children are common pediatric urological conditions.
  • The traditional understanding of VUR's etiology has been challenged by new urodynamic insights.

Purpose:

  • To re-evaluate the cause-effect relationship between VUR and UTI in children.
  • To highlight the role of voiding dysfunction in the development of VUR.
  • To emphasize the importance of addressing bladder dysfunction in VUR management.

Summary:

  • Vesicoureteral reflux (VUR) in children is primarily caused by underlying voiding dysfunction, not the presence of a urinary tract infection (UTI).
  • Dysfunctional voiding leads to increased intravesical pressure and post-voiding residuals, creating conditions for VUR when pressure exceeds ureteric opening pressure.
  • High voiding pressure was observed in 90% of infants with VUR, underscoring bladder dysfunction as a fundamental factor.

Impact:

  • Treatment strategies for VUR should prioritize the elimination of bladder dysfunction.
  • Endoscopic subureteric injection may serve as an adjunctive therapy to reduce febrile UTI recurrence in VUR patients.
  • This understanding shifts the focus from solely treating UTIs to addressing the root cause of VUR.

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