UROLOGY · CONDITIONS
Vesicoureteral Reflux (VUR)
Retrograde flow of urine from the bladder into the ureters and kidneys — a common paediatric condition causing recurrent kidney infections and renal scarring if untreated.
ABOUT THIS CONDITION
What is Vesicoureteral Reflux (VUR)?
Vesicoureteral reflux (VUR) is the abnormal retrograde flow of urine from the bladder into the ureters and renal pelvis during voiding. It is graded I–V based on degree of reflux and ureteral dilation. Infected reflux causes pyelonephritis and progressive renal scarring. Early identification and appropriate management prevent long-term kidney damage. Dr. Vipin provides VUR management for all grades — antibiotic prophylaxis and surveillance for low grades, endoscopic Deflux injection for grades I–III, and open or laparoscopic ureteric reimplantation for high-grade or persistent reflux.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- Short intravesical ureteral tunnel (primary VUR)
- Bladder outlet obstruction raising voiding pressures
- Posterior urethral valves in male neonates
- Neurogenic bladder from spinal cord conditions
- Duplicated collecting system — upper moiety VUR
- Ureteral ectopia or ureterocele displacement
CLINICAL DETAILS
KeyFacts
VCUG grades VUR I–V. Grade I–II often resolves spontaneously. Grade IV–V requires active treatment.
Technetium DMSA renal scan identifies renal scars caused by previous pyelonephritis episodes.
Low-dose prophylactic antibiotics reduce UTI risk while awaiting spontaneous resolution or surgery.
Endoscopic Deflux injection for grade I–III — 75–85% success. Day-care, no incision.
Cohen or Lich-Gregoir reimplantation for grade IV–V — >95% success rate. Definitive cure.
Underlying bladder overactivity or dysfunctional voiding must be treated concurrently.
HOW WE TREAT IT
Treatment Approach
Open Ureteric Reimplantation (Cohen's / Politano-Leadbetter)
The ureter is detached and reimplanted into the bladder wall through a longer submucosal tunnel that creates a permanent anti-reflux valve — the gold standard for grade IV–V VUR with >95% success rates.
- 1
VCUG & DMSA
Voiding cystourethrogram grades the reflux. DMSA scan identifies renal scarring and quantifies differential function in each kidney.
- 2
Antibiotic Prophylaxis
Low-dose daily prophylaxis prevents UTIs while the child is awaiting spontaneous resolution or surgery is planned.
- 3
STING Procedure
Endoscopic submucosal Deflux injection performed as a day-care cystoscopic procedure — 75–85% success for grade I–III reflux.
- 4
Reimplantation
Open or laparoscopic ureteric reimplantation for persistent high-grade or failed endoscopic treatment — >95% cure with definitive anti-reflux tunnel.
AVAILABLE TREATMENTS
Treatment Options
Ureteric Reimplantation (Cohen's / Politano-Leadbetter)
Reimplantation with a long submucosal anti-reflux tunnel — gold standard for high-grade VUR with >95% success.
Laparoscopic Extravesical Reimplantation (Lich-Gregoir)
Extravesical laparoscopic tunnel lengthening without opening the bladder — suitable for unilateral high-grade VUR.
Robotic Reimplantation
Robot-assisted reimplantation for precise tunnel creation in complex or redo cases using da Vinci instrumentation.
Endoscopic STING / HIT Procedure (Deflux injection)
Dextranomer hyaluronic acid bulking injection at the ureteric orifice — minimally invasive day-care procedure for grade I–III VUR.
COMMON QUESTIONS
Frequently Asked
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