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Vur is a common condition seen in children
This is a very common condition in children with wetting/urinary incontinence.
There are 2 basic ways of approaching this problem:
A trial for 3 to 6 months may resolve some of the issues. A further trial of anticholinergic medication may help.
Failure to respond to the above management plan may require the injection of botox into the bladder to relax the bladder muscle. If there is some response to this injection we may need to repeat this a few times upto a ?maximum of three times.
An operation called ‘bladder augmentation’ simply meaning making the bladder big may be necessary if the above conservative management fails.
This is a descriptive term used to denote a dilated ureter. The underlying reasons fo this dilatation can be an obstruction (beyond the dilatation or vesicoureteric reflux and in some cases both.
This finding can be detected on prenatal scans however the mild to moderately dilated ureter is difficult to detect on the prenatal ultrasound scans. The main stay of diagnosis is a renal tract ultrasound and an isotope scan to assess function in that and the opposite kidney.
Management
The management consists of close follow up with ultrasound scans and isotope scans as necessary. Surgery is indicated in cases where there has been urinary tract infection or the function in the ipsilateral kidney is below normal (< or = 40%).
The operation consists of going through the bladder, dissecting the ureter and repositioning it in the bladder after excising the ‘blocked’ end of the ureter.
The success rate of this operation is 98%.
Complications in 2 % are:
This may be the result of dysfunctional voiders who have failed to empty their bladder regularly and are now unable to void against the resistence of the bladder sphincter leading to a big bladder.
This can be treated by medications that may act on the bladder neck or the bladder sphincter.
In rare cases we may need to proceed to an operation that will give a channel from the bladder to the tummy wall so that the patient can pass urine via the normal passage but will need to empty this bladder via a catheter introduced through this newly formed channel.
This is a way of looking inside your child’s wee passage called urethra and their bladder to with a camera see if we can identify the underlying cause of his symptom / problem called diagnostic cystoscopy.
If we already have the cause of the underlying symptom / problem then it is possible to treat it in some of the conditions like vesicoureteric reflux (VUR), small capacity bladder causing urinary incontinence that has not responded to medications by injecting Botox called therapeutic cystoscopy.
This is done under a general anaesthetic carried out by paediatric anaesthetists skilled and experienced in their field, so your child will be asleep. In some cases we will give an antibiotic while asleep to prevent UTI. This is done as a day case procedure which means your child will come to the hospital having already had their preassessment and be able to go home the same day after recovering from the general anaesthetic and is well. It may be better to come prepared to stay one night but be allowed to go home the same day to avoid inconvenience to child and parents.
Once your child is allowed home a follow up outpatient appointment is made in some cases a follow up ultrasound scan may be needed which my secretary will arrange. The rest of the specific treatment will be discussed with you prior to discharge from hospital. A letter with details of the cystoscopy and findings and postoperative care will be sent to you as parents and your child's GP.
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