Pediatric Urology Clinic
Approximately 1 percent of newborns are at risk of developing vesicoureteral reflux, and this percentage increases to nearly 30 percent among siblings of children diagnosed with urinary reflux.
There are several causes of this condition, which can be classified as follows.
Primary Pathological Causes
Several primary pathological factors may be responsible for the backward flow of urine from the bladder into the ureter and then to the kidney. One of the most important causes is bacterial bladder infection, which can lead to scarring of the bladder and hardening at the ureteral opening within the muscular portion of the bladder. This area is naturally responsible for the ureterovesical valve mechanism. Hardening in this region reduces the valve’s ability to close properly, resulting in urinary reflux into the ureter or kidneys.
One of the advanced treatment options for urinary reflux is endoscopic injection at the ureteral opening into the bladder.
Secondary Pathological Causes
Secondary causes resulting from acquired conditions include narrowing or hardening of the bladder neck, the presence of median bars in the bladder neck, posterior urethral valve, urethral stricture due to previous surgical complications, and neurological bladder disorders.
Congenital Causes
Congenital factors include ectopic ureteral opening, developmental abnormalities of the bladder trigone, and insufficient length or angle of the ureter within the bladder muscle.
Diagnosis
When a child experiences recurrent urinary tract infections or when congenital abnormalities of the urinary system are detected before birth through prenatal ultrasound, medical consultation is essential. The physician may request several diagnostic tests to determine the cause.
Before initiating any treatment, whether conservative or surgical, it is crucial to accurately identify the underlying cause of urinary reflux. Diagnostic procedures may include renal, ureter, and bladder ultrasound, voiding cystourethrogram using contrast via catheterization to assess reflux severity and bladder structure, cystoscopy to examine the bladder and urethra, urodynamic studies to evaluate bladder pressure and function, and nuclear renal imaging using a DMSA scan to assess kidney damage caused by reflux.
Treatment
The primary goal of treating vesicoureteral reflux is to protect kidney function, prevent deterioration, and eliminate urine backflow.
Most studies have shown that urinary reflux may improve or completely resolve in a large percentage of children, especially as the child grows, even without medical treatment. However, treatment decisions generally depend on several factors, including the child’s age, the severity of reflux, associated symptoms, the degree of kidney involvement, and the level of adherence by the child and family to treatment plans.
The initial treatment phase focuses on addressing underlying causes that may lead to treatment failure if left unmanaged. These include bladder dysfunction due to neurological issues, urethral narrowing, or behavioral habits such as urine retention and delayed voiding.
Conservative treatment involves training the child to empty the bladder regularly seven to eight times per day, ensuring adequate fluid intake, and encouraging consumption of fruits and fiber rich foods to prevent constipation. Constipation is very common among children and is medically recognized as a contributing factor to urinary tract infections and persistent reflux.
Preventive low dose antibiotics may be prescribed to reduce the risk of bladder infections caused by urinary retention and reflux. This approach helps lower the likelihood of recurrent bacterial kidney infections, which can lead to kidney impairment and eventual renal failure.
If urinary reflux does not resolve after adequate medical follow up or in cases of recurrent urinary tract infections, surgical intervention becomes the next step. Significant advances in surgical techniques over recent years have greatly reduced treatment burden, recovery time, and discomfort for both children and their families.
Previously, surgical correction required an abdominal incision, bladder opening, and ureteral reimplantation using a tunneling technique to prevent reflux. Although this method has a success rate exceeding 95 percent, it requires prolonged hospitalization and bladder catheterization following surgery.
Modern treatment methods offer a much shorter hospital stay, usually less than 24 hours, minimal recovery time, fewer complications, and success rates comparable to traditional surgery.
This advanced approach is performed using cystoscopy without surgical incisions. A bulking agent is injected at the ureteral opening to strengthen the bladder wall and improve closure of the ureteral valve during bladder filling, thereby preventing urine reflux. These bulking agents are sugar based materials proven to be medically effective and stable over long periods without adverse reactions with surrounding tissues. In severe reflux cases, a second injection may be required.
Final Notes
Early diagnosis and treatment of pediatric urinary tract infections are essential. It is important to rule out vesicoureteral reflux as an underlying cause, particularly in cases of recurrent infections. Screening of siblings is also recommended when a child is diagnosed, due to the higher incidence of urinary reflux within the same family.
Frequently Asked Questions
What causes urinary tract problems in children?
Pediatric urinary tract conditions may result from primary causes such as bacterial bladder infections, secondary conditions such as bladder neck obstruction, or congenital abnormalities including defects in bladder trigone development or ureter positioning. These conditions can be accurately diagnosed and treated at Dr. Talal Merdad Medical Center.
How are urinary tract conditions diagnosed in children?
Diagnosis may involve ultrasound imaging, contrast bladder imaging, cystoscopy, and urodynamic testing to assess reflux severity and kidney involvement under the supervision of specialists at Dr. Talal Merdad Medical Center.
What treatment options are available for pediatric urinary tract conditions?
Treatment depends on the severity of reflux and the child’s age. Initial management usually involves conservative therapy including bladder training, adequate hydration, fiber rich diet, and preventive antibiotics. Advanced cases may require minimally invasive surgical intervention such as endoscopic bulking agent injection.
Can urinary reflux improve without treatment?
Yes. In many cases, urinary reflux may improve or resolve naturally as the child grows. Continuous medical follow up is essential to protect kidney function and prevent complications.
Do children with urinary reflux always need surgery?
Surgery is not always required. It is recommended only if conservative treatment fails or if recurrent infections persist. Modern minimally invasive techniques available at Dr. Talal Merdad Medical Center have significantly reduced recovery time and hospital stay.
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