Urology: Vesicoureteral Reflux (VUR)

Definition

• Retrograde Urine Reflux from Bladder into the Ureters

Presentation

• Hydronephrosis
• Recurrent UTI & Pyelonephritis
• Renal Injury/Failure

Diagnosis

• Diagnosis: Voiding Cystourethrogram (Gold Standard)
• Alternative Imaging: Radionuclide Cystogram or US
• Also Screen for Bladder & Bowel Dysfunction

International Study Classification

• Grade I: Urine Reflux into the Ureter Only
• Grade II: Urine Reflux into the Ureter, Renal Pelvis & Calyces, Without Dilation
• Grade III: Mild-Moderate Dilation/Tortuosity of the Ureter & Renal Pelvis with Minimal Blunting of the Fornices
• Reflux with Mild Dilation of the Ureter & Pyelocalyceal System
• Grade IV: Moderate Dilation/Tortuosity of the Ureter & Renal Pelvis/Calyces with Complete Obliteration of the Sharp Angles of the Fornices but Maintenance of the Papillary Impressions in the Majority of the Calyces
• Grade V: Gross Dilation/Tortuosity of the Ureter & Renal Pelvis/Calyces with No Visible Papillary Impressions in the Majority of the Calyces

Treatment

• No Ureter Dilation (Grade I-II): Conservative Management
• Ureter Dilation (Grade III-V): Surgical Reimplantation (Long Bladder Segment) or Endoscopic Correction