Vesicoureteral Reflux
Vesicoureteral Reflux
Structure of Normal urinary tract:
The urinary tract is made up of the kidneys, ureters, bladder and urethra. The kidneys are located high up in the tummy and responsible for filtering waste products from the bloodstream and produce urine continuously. The urine flows down the tubes called ureters from the kidneys to the bladder, which normally stores urine and empties intermittently by muscular contraction. The urine exits the bladder through the urethra in a process is called voiding or urination.
When the ureter joins the bladder it travels through the wall of the bladder for a distance creating a tunnel so that a flap valve is created. This valve prevents back flow of the urine into kidneys when the bladder is full or the child is passing urine. Thus, when the bladder fills and later when it squeezes down to empty, back-up (that is, reflux of urine) is prevented because the valve operates in the same way as when you pinch off a soda straw. This valve-like action is important for several reasons:
➾ prevents bacteria (that often get into the urine) from getting to the kidneys
➾ protects the ureters and kidneys from high pressures generated by the bladder during urination
➾ permits removal of all of the stored urine with a single act of urination, because the bladder urine has nowhere to go other than out the urethra
Diagram of normal urinary tract
Diagram of ureter tunneling through bladder wall
Structure of Normal urinary tract:
The urinary tract is made up of the kidneys, ureters, bladder and urethra. The kidneys are located high up in the tummy and responsible for filtering waste products from the bloodstream and produce urine continuously. The urine flows down the tubes called ureters from the kidneys to the bladder, which normally stores urine and empties intermittently by muscular contraction. The urine exits the bladder through the urethra in a process is called voiding or urination.
When the ureter joins the bladder it travels through the wall of the bladder for a distance creating a tunnel so that a flap valve is created. This valve prevents back flow of the urine into kidneys when the bladder is full or the child is passing urine. Thus, when the bladder fills and later when it squeezes down to empty, back-up (that is, reflux of urine) is prevented because the valve operates in the same way as when you pinch off a soda straw. This valve-like action is important for several reasons:
➾ prevents bacteria (that often get into the urine) from getting to the kidneys
➾ protects the ureters and kidneys from high pressures generated by the bladder during urination
➾ permits removal of all of the stored urine with a single act of urination, because the bladder urine has nowhere to go other than out the urethra
The ureter is shown tunneling through the bladder wall.
1-if the tunneling of the ureter ends here, reflux is likely.
2-if the tunneling of the ureter ends here, reflux is possible.
3-if the tunneling of the ureter ends here, reflux is unlikely.
Secondary reflux: Some children have reflux because of underlying problems such as lower urinary obstruction (such as urethral valves), abnormal bladder behavior (such as uninhibited bladder contractions or hyperreflexic bladders), infrequent voiding, or constipation. IN such children, the primary treatment is towards the underlying disease which led to reflux and generally reflux subsides when the underlying condition is treated.
Normal kidney, ureter, and bladder
Grade I Vesicoureteral Reflux: urine (shown in blue) refluxes part-way up the ureter
Grade II Vesicoureteral Reflux: urine refluxes all the way up the ureter
Grade III Vesicoureteral Reflux: urine refluxes all the way up the ureter with dilatation of the ureter and calyces (part of the kidney where urine collects)
Grade IV Vesicoureteral Reflux: urine refluxes all the way up the ureter with marked dilatation of the ureter and calyces
Grade V Vesicoureteral Reflux: massive reflux of urine up the ureter with marked tortuosity and dilatation of the ureter and calyces
Treatment of VUR
Since many children will outgrow their reflux, the usual plan is to follow up carefully and prevent infections in the interim. Regular tests such as VCUG, renal ultrasound, or nuclear voiding cystogram may be done when required. During this follow-up period they are kept on a prophylactic (low-dose) antibiotic to keep the urine free of infection. Any fever or new urinary tract symptoms (such as burning, frequency, urgency, straining, foul odor, bloody urine, or unusual incontinence) may indicate infection and must be promptly evaluated with urine analysis and urine culture. Children who develop breakthrough urinary infections in spite of antibiotic prophylaxis are at risk for kidney damage and may need surgical correction of reflux.
Surgery for Reflux
Correction of reflux is recommended for high grades of reflux, for reflux that fails to resolve, or for patients with breakthrough infections. Options are:
➾ Endoscopic injections of bulking agents: A small endoscope called cystoscope is placed into bladder and a thick viscous gel called Deflux is injected into the mucosa under the ureteric opening. This leads to creation of a mound which prevents reflux. Advantages include- no cuts, no pain and no post-op complications. Disadvantages are – not 100% successful, can’t be recommended for high grade reflux, gel is expensive and recurrence rate of 10%.
➾ Ureteric re-implantation: Surgical correction of reflux involves recreation of the tunnel and the valve function for the ureteric opening. This can be done via a small incision in the lower part of the tummy or in selected cases laparoscopically. The success rates are more than 95% in properly selected and evaluated patients.
Long term prognosis and follow-up
Children with a history of reflux should probably be monitored life-long with measurement of height and weight, blood pressure, and urine analysis. Occasional ultrasound tests will assure that kidney growth is on target for age and size. If there is any doubt about scarring or kidney function, the pediatric nephrology is also called in to evaluate and manage.
Family members & siblings
If one child in a family has reflux, there is a 20% chance of having reflux in a sister or brother. Because we know that the chances of kidney damage are highest in the first 6 years of life, we think that brothers and sisters in that age range should be studied (with examination and atleast an ultrasound). Also if there is any symptoms suggestive of urinary infection, a VCUG should be done.
Testimonials
Real reviews from our patients on Google
Satyam Salvi 2nd
1 week ago
I would like to express my sincere appreciation to Dr. Manish Dubey and the entire hospital staff for the excellent care I received during my kidney stone treatment. Dr. Dubey was very friendly, supportive, and caring throughout my treatment, which made me feel comfortable and confident.
I am also very thankful to the entire hospital team for their helpful and professional service. The hospital was clean and well maintained, which made my overall experience very positive.
Thank you, Dr. Manish Dubey and the entire staff, for your care, kindness, and support. I truly appreciate the treatment and would gladly recommend your services to others.
Satyam Salvi
Read moreI am also very thankful to the entire hospital team for their helpful and professional service. The hospital was clean and well maintained, which made my overall experience very positive.
Thank you, Dr. Manish Dubey and the entire staff, for your care, kindness, and support. I truly appreciate the treatment and would gladly recommend your services to others.
Satyam Salvi
MAHESH BAPU SONAWANE
1 week ago
Excellent Doctor – Highly Recommended!
A heartfelt thank you to Dr. Bharat Sir for performing my right proximal ulna fracture plating surgery. His expertise, professionalism, and caring nature made my treatment experience very reassuring. He explained the treatment process clearly and provided excellent guidance and support throughout.
I truly appreciate his dedication, humble behaviour, and patient-friendly approach. I am very satisfied with my treatment and grateful for his care.
Thank you, Dr. Bharat Sir, for your excellent treatment and support! Highly recommended for his expertise and compassionate care. 🙏⭐⭐⭐⭐⭐
Read moreA heartfelt thank you to Dr. Bharat Sir for performing my right proximal ulna fracture plating surgery. His expertise, professionalism, and caring nature made my treatment experience very reassuring. He explained the treatment process clearly and provided excellent guidance and support throughout.
I truly appreciate his dedication, humble behaviour, and patient-friendly approach. I am very satisfied with my treatment and grateful for his care.
Thank you, Dr. Bharat Sir, for your excellent treatment and support! Highly recommended for his expertise and compassionate care. 🙏⭐⭐⭐⭐⭐
Swati Shinde
2 weeks ago
I had a very good experience at Mitr Hospital. The overall workflow was smooth and well-organized. The staff were helpful, supportive, and cooperative throughout the process. Special appreciation to the front desk team and the ward assistants for their polite behaviour, prompt assistance, and excellent coordination. They guided me properly and made the entire experience comfortable and hassle-free. Thank you to the entire team for your kind support and good service. Highly recommended!👍🏻😇
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Pushpa Kothari
3 weeks ago
Dr G Bharat Kumar done my mother’s robotic total knee replacement surgery. Fore surgery Dr Bharat guided so well. We are very much confident for surgery after counselling by doctor. Post surgery care is as excellent. All staff from top to bottom are good and helpful. Special thank you to Dr. Bharat.
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Asiino Tetso
1 month ago
My son's hypospadias surgery in Delhi was not successful and we opted for MITR Hospital Navi Mumbai and it was so good for us. Doctors Ashwitha Shenoy and AK Singal are very professional and friendly. In Delhi they don't allow my boy to move for 7 days before dressing. However, here they discharged us on the second day of the surgery. Doctors explained to us everything about the surgery which was never done in the previous hospital. Nurses and other staffs are friendly too and greet us with a smile on their faces which is another bonus too. My son didn't find any difficulty and we as parents are so much at peace too when the doctors are readily available everytime we try to contact them. We are from Nagaland and we came home so satisfied and happy.
We are specially grateful to Dr Ashwitha Shenoy for her motherly love and care for our little hero. We will remain grateful to her. My son had so much traumatic experiences with doctors and nurses in his previous treatments that he doesn't like any of them but here he says Dr Shenoy is "our friend"😍May God grant enough wisdom and good health to our doctors and nurses that they continue to serve us with love and care. God bless their families.
Read moreWe are specially grateful to Dr Ashwitha Shenoy for her motherly love and care for our little hero. We will remain grateful to her. My son had so much traumatic experiences with doctors and nurses in his previous treatments that he doesn't like any of them but here he says Dr Shenoy is "our friend"😍May God grant enough wisdom and good health to our doctors and nurses that they continue to serve us with love and care. God bless their families.
NISHIT JOSHI
1 month ago
I had consulted Dr. Manish Dubey for kidney stone and prostate-related issues, and my experience was excellent. Dr. Dubey performed the procedure using a minimally invasive approach, making the entire process virtually painless and comfortable.
What impressed me most was his patience in explaining every aspect of the condition, treatment options, and expected outcomes. He ensures that patients are well-informed and confident throughout their treatment journey.
I would also like to appreciate MITR Hospital for its professionalism, ethical medical practices, and patient-centric approach. The hospital offers high-quality healthcare services at very competitive pricing, making it truly value for money.
I highly recommend Dr. Manish Dubey and MITR Hospital to anyone seeking expert and compassionate urological care.
Nishit Joshi
Read moreWhat impressed me most was his patience in explaining every aspect of the condition, treatment options, and expected outcomes. He ensures that patients are well-informed and confident throughout their treatment journey.
I would also like to appreciate MITR Hospital for its professionalism, ethical medical practices, and patient-centric approach. The hospital offers high-quality healthcare services at very competitive pricing, making it truly value for money.
I highly recommend Dr. Manish Dubey and MITR Hospital to anyone seeking expert and compassionate urological care.
Nishit Joshi
Pritirekha P Nandeshwar
1 month ago
A heartfelt thank you to Dr. Bharat Kumar
We had heard a lot about Dr. Bharat Kumar, but after experiencing his treatment personally, we truly understood why he is so highly respected.
Last year, my mother met with an accident and suffered a serious knee injury. Her initial surgery was done in Guwahati, but unfortunately, her condition became worse afterwards. We were very worried and then decided to consult Dr. Bharat Kumar at MITR Hospital.
His advice and treatment were a true blessing for my mother. He explained everything patiently, gave us confidence, and treated her with great care and expertise. We have had multiple experiences with him, and every time, we have been extremely satisfied.
Thank you, Dr. Bharat Kumar, for your dedication, guidance, and compassionate care. You are truly an asset to MITR Hospital. 🙏
Read moreWe had heard a lot about Dr. Bharat Kumar, but after experiencing his treatment personally, we truly understood why he is so highly respected.
Last year, my mother met with an accident and suffered a serious knee injury. Her initial surgery was done in Guwahati, but unfortunately, her condition became worse afterwards. We were very worried and then decided to consult Dr. Bharat Kumar at MITR Hospital.
His advice and treatment were a true blessing for my mother. He explained everything patiently, gave us confidence, and treated her with great care and expertise. We have had multiple experiences with him, and every time, we have been extremely satisfied.
Thank you, Dr. Bharat Kumar, for your dedication, guidance, and compassionate care. You are truly an asset to MITR Hospital. 🙏
Kranti Tandel
3 months ago
From the moment I walked into the hospital until the day I was discharged, I felt genuinely cared for.
A heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Read moreA heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Shilpa Nair
4 months ago
I had an excellent experience and am very grateful for the care and support I received. The entire staff was professional, friendly, and attentive, making me feel comfortable throughout the process.
A special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Read moreA special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Mahendra Patil
4 months ago
My 3 years 11 month year old daughter was diagnosed with 10 mm kidney stone Dr.A.k.Singhal,Dr.Manish Dubey,and Dr.Ashwita Shenoy performed the surgery to remove the stone on May 30th with immense success. I am deeply grateful for the exceptional care and professionalism demonstrated by this entire team.
From the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Read moreFrom the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Purva Shingare
5 months ago
Had kidney stone surgery done by Dr Manish Dubey. All staff was cooperative. Doctor Dubey made me so much relaxed that I was not at all worried about the procedure. Other doctors in the OT were also very sweet. The staff is very nice, hospital is clean ,no smell of medicines, housekeeping services are very good. Hospital food is also very nice,tasty and healthy. Insurance procedure is also very easy. The surgery procedure went so smoothly. I would surely recommend Mitr Hospital and special thanks to Dr Dubey.
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Nikita Ghodke
7 months ago
I had an amazing experience at the hospital, which offers excellent facilities and truly stands out in terms of care and support. I was under the treatment of Dr. Vijaykumar Yadav, who is exceptional in his field. His kindness, compassion, and dedication to his work made a significant difference throughout my journey.
He is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Read moreHe is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Dimple Choudhary
1 year ago
Very polite staff N great service ☺️
Ketan Bhagat
1 year ago
Excellent,
We had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Read moreWe had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Pankaj Choudhary
1 year ago
Very experienced Doctor and cooperative staff. They give full time to patients for there Query and problems.
Blood test Camp organised for Woman's day was support and very helpful
Read moreBlood test Camp organised for Woman's day was support and very helpful
Sneha Omale
1 year ago
डॉ. अमित घरत इंडॉस्कॉपी खूप छान पध्दती ने केली . धन्यवाद डॉक्टर आणि त्यांची टीम . वेळोवेळी मदत केली बद्दल.
prathamesh palkar
1 year ago
“I am extremely grateful for the excellent service provided by Mr.Aditya Sir from the hospital TPA insurance team. He was incredibly professional, patient, and thorough in explaining my insurance coverage and guiding me through the entire process. His prompt assistance and dedication made everything smooth and hassle-free. I truly appreciate his kindness and efficiency in handling my queries. Thank you, Aditya Sir, for your outstanding support!”
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