Vesicoureteric Reflux

winking ureters

This 1 year-old female presented with urinary tract infection. Transverse ultrasound of the bladder shows intermittent dilatation of the distal ureters, up to 8mm diameter.

The intermittent dilatation gives the ureters a “winking” appearance. There is also debris in the bladder, consistent with cystitis. The kidneys appeared normal. The findings, along with the clinical history, were strongly suggestive of vesicoureteric reflux, and micturating cystourethrogram was recommended.

A normal renal ultrasound does not exclude VUR, and further imaging is required if the diagnosis is suspected clinically. Vesicoureteric reflux is diagnosed by micturating cystourethrogram or nuclear medicine cystogram. The latter is associated with lower radiation dose and may be useful for follow-up studies. MCU gives better anatomical detail.

Vesicoureteric reflux is a common problem in children, usually presents with urinary tract infection, and leads to renal scarring and impairment if untreated. There is a 25% incidence in siblings of patients with VUR. Prognosis is dependant on severity. The majority outgrow the reflux, and prophylactic antibiotics may be all that is required. Ureteric reimplantation surgery is reserved for more severe reflux or recurrent infection.

Reference: Donnelly, et al. PocketRadiologist: Paediatrics Top 100 Diagnoses. Amirsys 2002

Credit: Dr Laughlin Dawes