الفهرس 
DEMOGRAPHIC, EPIDEMIOLOGY PREVELANCE, AND ETIOLOGYOnly 14 pages are availabe for public view
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Abstract
V
esicouretric reflux ”VUR” or the retrograde flow of urine from the bladder into the ureter is an anatomic and or functional disorder with potentially serious consequences such as renal scarring, hypertension, and renal failure the prevalence of VUR in normal children has been estimated at 0.4–1.8% VUR has a well-recognised genetic component, although the mode of inheritance remains unclear VUR demonstrates important gender differences, with girls being more likely to suffer than boys.
The phenomenon of vesicoureteral reflux represents a balance of several factors. These factors include the functional integrity of the ureter, the anatomic composition of the ureterovesical junction (UVJ), and the functional dynamics of the bladder The severity of VUR is measured using the grading system according to the International Reflux Study Committee Primary or congenital VUR is caused by a congenital maldevelopment of the vesicoureteral junction, which is too short and has a possible lack of a fixed attachment between the ureter and the detrusor.
Secondary reflux develops under the influence of anatomic or functional infravesical obstructions due to inflammatory or neuropathic disorders of the bladder. Although most children with VUR will have excellent long-term prognosis, a small group has a significant risk. This risk can be minimized in areas with good medical health care where prompt diagnosis and treatment of acute UTI is possible. Reflux of infected urine into the upper urinary tract was postulated to be the cause of chronic pyelonephritis and subsequent renal damage.
VUR can be symptomatic or asymptomatic. Symptoms can be in the form of recurrent urinary tract infections (UTIs) with and without fever. Younger children may present with failure to thrive or recurrent otitis media that can mask and delay the diagnosis of VUR.
The voiding symptoms will often result in a dysfunctional elimination syndrome and may add bowel dysfunction, such as constipation and hypertension as reflux nephropathy is one of the major causes of childhood hypertension and chronic renal failure.
Ultrasound remains a part of the routine evaluation of first time UTI because it can assist in depicting structural abnormalities such as asymmetric renal size, hydronephrosis and duplex kidneys.
The voiding cystourethrography (VCUG) is the most common fluoroscopic examination for paediatric patients. It provides useful anatomical and functional assessment of the lower urinary tract.
TC99m_DMSA is the imaging of choice to detect acute pyelonephritis and renal scarring because of its high sensitivity
Magnetic resonance imaging can detect VUR. There is no ionizing radiation, excellent anatomic detail and offers the ability to assess the kidneys for anomalies and reflux nephropathy.
Positional instillation of contrast (PIC) cystography was developed to detect occult VUR in patients with recurrent urinary tract infections (UTI) after a negative standard voiding cystogram.
The objective of conservative management is to prevent UTI while avoiding the potential harms of surgery. The underlying assumption in using this management approach is based on the understanding that VUR may resolve spontaneously in a large percentage of children.
Prevention of febrile UTI or pyelonephritis is one of the primary goals of surgical management.
In general, surgical intervention was recommended in patients who were older at initial presentation, and had dilating, bilateral, or persistent reflux, and renal scarring. Following FDA approval of Deflux® as a bulking agent for the treatment of VUR grades 1–4, high-grade reflux Low probability of spontaneous resolution, renal scarring, recurrent pyelonephritis, breakthrough febrile UTI while on continuous antibiotic, prophylaxis, and parental preference.
Options for surgical repair of VUR include open, laparoscopic, and endoscopic techniques.
The surgical objective of ureteral reimplantation is to create a passive flap valve mechanism that allows the ureter to occlude temporarily while the intravesical pressure rises within the bladder, therefore preventing VUR from occurring.