Vesicoureteric Reflux

The reported incidence of vesicoureteric reflux varies greatly from 2 to nearly 50% [27,41]. The varia tion appears to depend entirely upon the number of patients who undergo a diagnostic micturating cystogram to detect reflux. In a cohort who all had cystograms, 33% presented with reflux; however, this represented a selected group [27]. In a prospectively studied group, 10 out of 45 (22%) had vesicoureteric reflux; 4 of these (9%) had structurally normal upper tracts at presentation. All grades of reflux have been described: in 1996, Boemers et al. reported that 27% of their cohort had reflux; of the 24 patients (37 kidneys) with reflux, 6 were grade I, 4 were grade II, 5 were grade III, 9 were grade IV, and 3 were grade V [3,4]. This suggests that higher-grade reflux is seen than in patients with primary vesicoureteric reflux; however, large series have not been well reported and an association between reflux with and that without a neuropathic bladder has not been documented.

The management of reflux follows the same principles as all patients with primary reflux. In 18 patients with reflux, 10 spontaneously improved, 3 are still being observed, and 5 had the reflux corrected [30]. Neither the initial grade of reflux nor the indication for surgical treatment, however, was mentioned. Division of the rectourinary fistula and subsequent decrease in bacterial contamination frequently leads to resolution of lower grades of reflux [9,43]. This report and others, suggest that a policy of observation and expectant management is appropriate for these patients.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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