Vesicoureteral reflux causes urine to back up into the kidneys. Endoscopic injection is a minimally invasive treatment with a success rate of up to 90%
Vesicoureteral reflux is a condition in which there is an abnormal flow of urine from the bladder to the kidneys. Normally, urine flows from the kidneys to the bladder via the ureters in a unidirectional way, without going backwards. However, in the case of vesicoureteral reflux there is a malfunction in the valves that normally prevent this return, allowing the urine to flow backwards.
Endoscopic injection for vesicoureteral reflux is an advanced and less invasive solution to correct this condition that affects the normal flow of urine. This technique offers an effective approach, especially in cases of mild to moderate reflux.
In this article we're going to talk about what vesicoureteral reflux is and the treatment of this anomaly using endoscopic injection. Read on to find out.
What is vesicoureteral reflux?
Vesicoureteral reflux is a more common condition in children and is usually associated with congenital anomalies in the valves or positioning of the ureters. This anomaly can vary in severity and is classified into different degrees.
According to Dr. Ubirajara Barroso Jr., head of the division of reconstructive urological surgery and pediatric urology at the Federal University of Bahia Hospital (UFBA), mild reflux (grades 1 and 2) often resolves spontaneously, while more severe cases may require intervention. In milder cases, reflux can resolve spontaneously as the child grows, while more severe cases can increase the risk of urinary infections and kidney damage.
"Depending on the degree of reflux, there is a good tendency for spontaneous resolution, for example, grades 1 and 2 have more than 70% resolution without the need for treatment, while grades 3, 4 and 5 depend on whether it is unilateral or bilateral, with less than 10% resolution when reflux is grade 5 bilaterally," explains Dr. Barroso.
According to Dr. Ubirajara Barroso, who is also head of the Urinary System Unit at the Professor Edgard Santos University Hospital (UFBA), reflux can be primary or secondary:
- Primary vesicoureteral reflux:
"It's when the child is born with it due to a congenital incompetence of the valve at the entrance of the ureter into the bladder. The ureter is the channel that connects the kidneys to the bladder," he describes.
- Secondary vesicoureteral reflux:
"Secondary reflux is when there is an increase in bladder pressure, decompensating the ureter valve and causing urine to return to the kidneys. This is the case with neurogenic bladderdysfunctions and bladder obstructions, such as the posterior urethral valve," he explains.
Diagnosis of vesicoureteral reflux
Vesicoureteral reflux can be diagnosed using tests such as voiding cystourethrography and contrast echo.
"Reflux is asymptomatic and the diagnosis is usually based on symptoms of urinary infection. Infants usually present with fever with no apparent focus, i.e. fever is the only symptom, and in older children, especially after weaning, they present with symptoms of cystitis, such as burning to urinate, dysuria, urinary urgency and urinary incontinence", she describes.
Dr. Ubirajara Barroso points out that the diagnosis of vesicoureteral reflux is made using a test called voiding cystourethrography. "This is a test in which a probe is passed into the urethra, contrast is injected and it is observed whether the contrast returns to the kidneys," he points out.
According to Dr. Barroso, in this test echogenic substances are injected into the bladder and the test is then carried out by ultrasound.
Scintigraphy is also a test that can be used to diagnose vesicoureteral reflux. "It has good sensitivity for diagnosis, but the disadvantage is that reflux cannot be graded by this method," he says.
Endoscopic injection to treat vesicoureteral reflux (H2)
While reflux is observed clinically, children are usually treated with preventative antibiotics in small daily doses to avoid episodes of infection. When urinary infection occurs despite the use of antibiotics, or if reflux persists, intervention may be indicated.
The doctor advises that cases with urinary infection need interventional treatment or a less invasive treatment, which is endoscopic injection. "We inject substances into or under the ureter that are poorly absorbed, and this reshapes the valve," he says.
Endoscopic injection is the main indication for refluxes ranging from grade 1 to 4. Eventually, grade 5 refluxes with a not so large ureteral diameter can also be treated by endoscopic injection.
"This type of treatment currently has the great advantage of having a success rate of up to 90% of cases and can be carried out without cuts in a day hospital setting," says the specialist.
This approach is carried out in just one session, on a day hospital basis, and offers a significant success rate. The endoscopic injection has minimal post-procedure restrictions, allowing daily activities to be resumed quickly.
"If it fails, it can be repeated. From then on, if the reflux persists, open surgery is indicated. However, with technical developments and injected materials, the chance of failure is less and less, and today open surgery is performed less frequently," he points out.
Have you noticed any of the signs mentioned in this text in your child? Make an appointment.
SEE ALSO: Read an article with Dr. Ubirajara on vesicoureteral reflux in Correio Braziliense