very importantly: ultrasound cannot exclude vur. ie it is a poor negative predictor.
vur is incompetence of the ‘valve’ like insertion of the ureter into the bladder, allowing urine to reflux back up from the bladder, particularly during micturition.
the ureter actually passes through a ‘mucosal-tunnel’ in the bladder wall. bladder filling
- grade i – reflux into nondilated ureter
- grade ii – reflux into renal pelvis and calyces without dilation
- grade iii – reflux with mild to moderate dilation and minimal blunting of fornices
- grade iv – reflux with moderate ureteral tortuosity and dilation of pelvis and calyces
- grade v – reflux with gross dilation of ureter, pelvis, and calyces, loss of papillary impressions, and ureteral tortuosity.
ref: the international reflux study in children. j urol. nov 1992
the primary 2 presentations are:
- pyelectasis or hydronephrisis/hydroureter seen on antenatal ultrasound
- urinary tract infection.
there is differing opinion on the best primary investigation for neonates/infants.
- dmsa – dimercaptosuccinic acid
- mcu – micturating cysto-urethrogram
- radionucleid cystography