Vesicoureteral Reflux (VUR) Treatment in Malaysia

What is Vesicoureteral Reflux (VUR)?

Vesicoureteral reflux occurs when urine leaves the bladder in the wrong direction and returns via the ureteric tubes, which link the kidneys and bladder. Urine usually travels from the kidneys to the bladder via the ureters. It is not intended to flow upward again.

Vesicoureteral reflux most frequently affects children and babies. Some people are born with it because of a structural problem with one of the two ureters, while others get it later due to factors like incomplete bladder emptying.

What is the Importance of Timely Treatment?

• It is essential to treat Vesicoureteral Reflux (VUR) as soon as possible to avoid kidney damage, UTIs, and potential long-term issues like renal failure or kidney scarring.
• Early intervention, by treating reflux before it causes irreversible damage, helps maintain kidney function and prevent recurrent infections.
• Additionally, timely therapy prevents the illness from worsening and necessitates more invasive procedures.

What are the Common Symptoms of Vesicoureteral Reflux (VUR)?

Urinary tract infections (UTIs) frequently cause symptoms of vesicoureteral reflux. These signs may consist of:

• An intense, ongoing need to urinate
• The sensation of burning when urinating
• The frequent need to pass small volumes of pee
• Cloudy urine
• Fever
• Discomfort in the stomach, groin, or side

Babies and some young children with UTIs cannot communicate their symptoms to adults. However, they might have:

• Fever without any apparent cause
• Lack of hunger
• Fussiness

If left untreated, vesicoureteral reflux in children can result in:

• Wetting the bed
• Loss of control over bowel movements or constipation
• Elevated blood pressure
• Urine that contains protein
• Urinating urgently or more frequently than usual is necessary
• Urinary incontinence is the term for accidentally leaking pee
• Hydronephrosis

Types of vesicoureteral reflux

The two types of VUR are primary and secondary:

• Primary VUR: Most VUR cases are primary, typically affecting only one kidney and one ureter (unilateral reflux).
• Secondary VUR: Secondary VUR happens when a blockage in the urinary tract raises the pressure and forces urine back into your child's kidneys, ureters, or bladder from the urethra.

Stages of Vesicoureteral Reflux (VUR)

• Grade 1: The ureter is a standard width, but the urine travels backwards.
• Grade 2: Pee backs up into the renal pelvis, where the kidney and ureter connect, and a ureter. The ureter and renal pelvis have not widened.
• Grade 3: Due to pee backing up, the ureter(s), renal pelvis, and calyces, where urine collecting starts in the bladder, are mildly to moderately enlarged.
• Grade 4: Due to excessive pee backing up, the kidney pelvis and calyces are substantially enlarged, and the ureter or ureters are curved.
• Grade 5: There is significant enlargement and distortion of the ureter or ureters. Due to an excessive volume of urine backing up, the renal pelvis and calyces are substantial.

Causes, Risk Factors and Complications of Vesicoureteral Reflux (VUR)

Causes

Primary vesicoureteral reflux: Vesicoureteral reflux comes in two primary forms, each with its own causes.

Children often develop vesicoureteral reflux due to a valve issue, allowing urine to flow back up the ureters. The valves may improve as they grow, and this condition may be genetically inherited.

Secondary vesicoureteral reflux: This kind of reflux is typically caused by improper bladder emptying, but it can happen for a variety of reasons.

Risk Factors

Vesicoureteral reflux risk factors include:

• Bladder and bowel dysfunction (BBD): Children with BBD retain faeces and urine.
• Assigned sex at birth: Generally speaking, girls are far more likely than boys to have this illness. Vesicoureteral reflux that is present from birth is an exception. Boys are more likely to experience this.
• Age: Vesicoureteral reflux is more common in infants and young children up to age two than in older kids.
• Family history: In most cases, primary vesicoureteral reflux runs in families. The disorder is more likely to affect children whose parents had it.

Complications

Vesicoureteral reflux disease (VUR) in children can lead to the following complications:

• Bladder and kidney infections are examples of urinary tract infections (UTIs).
• Bladder issues, such as bedwetting, urine retention, and incontinence.
• Elevated blood pressure
• Kidney damage (Nephrotic syndrome), kidney scarring, and chronic kidney failure (Rarely).

Latest Research and Technologies in the Treatment of Vesicoureteral Reflux (VUR) in Malaysia

Recent developments in Malaysian Vesicoureteral Reflux (VUR) treatment centre on less invasive approaches and enhanced diagnostic capabilities.​

• Endoscopic Treatment with Dextranomer/Hyaluronic Acid (Dx/HA): This minimally invasive technique involves injecting a bulking agent at the vesicoureteric junction to stop reflux. Research has indicated a good success rate with few problems, especially in lower-grade VUR.
• Robotic-Assisted Laparoscopic Surgery: Compared to open surgery, robotic-assisted laparoscopic ureteral reimplantation provides accuracy and a shorter recovery period for difficult or high-grade VUR. Even though the results are encouraging, further study is required to determine long-term effectiveness.

Vesicoureteral Reflux (VUR) Prevention Tips

Diet, lifestyle modifications, or medication cannot prevent vesicoureteral reflux (VUR). However, you may take actions to enhance the general health of your child's urinary system.

Ensure that your child.

• Consumes adequate water.
• Changing their diaper should be done right away after urination and defecation.
• Pees regularly and avoids “holding it.”
• As quickly as possible, constipation and faecal or urinary incontinence are treated.