Original Research
Efficacy of surgical techniques and factors affecting residual stone rate in
the treatment of kidney stones
Dr. Anil Haripriya


1Associate professor, Department of General Surgery CIMS, Bilaspur (C.G.), India;
2Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur (M.P.), India
ABSTRACT:
Background: The present study was conducted to assess efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. Materials & Methods: 102 patients of kidney stones of both genders were divided
into 3 groups. Group I patients underwent open stone surgery, group II patients underwent percutaneous nephrolithotomy
(PNL) and group III underwent retrograde intrarenal surgery (RIRS). Surgical techniques complications were evaluated.
Results: In group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9 cm2
. The mean
operative time in group I was 84.2 minutes, in group II was 118.4 minutes and in group III was 78.6 minutes. There were 9
cases in group I, 7 in group II and group III was 5 cases. There were 7 cases of fever in group I, 4 in group II and 2 in group
III, infection 2 in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II.
The difference was significant (P< 0.05). Conclusion: PNL and RIRS have been seen as safe and effective methods as
compared to open method in case of kidney stones.
Key words: Percutaneous nephrolithotomy, Retrograde intrarenal surgery, Kidney stone.
Received: 13 September, 2020 Accepted: 18 November, 2020
Correspondence: Dr. Arvind Baghel, Associate Professor, Department of General Surgery, NSCB Medical College,
Jabalpur (M.P.), India
This article may be cited as: Haripriya A, Baghel A. Efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. J Adv Med Dent Scie Res 2020;8(12):55-58.
INTRODUCTION
Urinary system stone disease is one of most
frequently encountered diseases in the urology
practice. The stones are frequently observed in the
renal localization, and most of them require
intervention.1 Kidney stone disease, also known as
urolithiasis or renal calculi contributes to one of the
most common health problems in the daily lives of
men and women. It occurs when a solid piece of
material (stone) forms in the urinary tract.2
Approximately 12% of men and 6% of women in the
USA and 10 to 15% of people in Europe and North
America are affected by it. Calcium oxalate (CaOx) is
found to one component of the most common kidney
stones. It has been proposed that the most likely stone
formation mechanism for people with idiopathic
CaOx stones is caused by CaOx overgrowth in renal
papillary Randall’s plaque.
3
Preventive measures such
as dietary therapy and therapeutic treatments such as
drugs and surgical techniques have been verified to be

effective in the treatment of renal calculi. Dietary
modification is a safe and economical preventive
measure for dietary therapy, and in some cases, drugs
are important to reduce the risk of stone formation.
Unfortunately, since the 1980s, there have been no
new drugs developed for the prevention of renal
calculi after the introduction of potassium citrate.4
Some of these methods include percutaneous
nephrolithotomy (PCNL), extracorporeal shockwave
lithotripsy (SWL), retrograde intrarenal surgery
(RIRS), etc. Extracorporeal shock wave lithotripsy
(ESWL) into clinical practice after 1980s, a new era
had begun in the treatment of urinary system stone
disease. In recent years, percutaneous
nephrolithotomy (PNL) has taken increasingly greater
part in the treatment of stone disease with success
rates nearing to 80 percent.5 The present study was
conducted to assess efficacy of surgical techniques
and factors affecting residual stone rate in the
treatment of kidney stones.
Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies NLM ID: 101716117
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Haripriya A et al. Treatment of kidney stones.

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Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
MATERIALS & METHODS
The present study was conducted among 102 patients
who underwent surgical treatment of kidney stones of
both genders in the department of general surgery in a
medical college hospital. All were informed regarding
about the study and their consent was obtained.
Data such as name, age, gender etc. was recorded.
Patients were divided into 3 groups. Group I patients
underwent open stone surgery, group II patients
underwent percutaneous nephrolithotomy (PNL) and

group III underwent retrograde intrarenal surgery
(RIRS).
Endoscopic stone surgery was performed for stone
fragmentation in all patients using pneumatic
lithotriptor or Holmium: YAG laser. Surgical
techniques complications were evaluated. Stones
equal or larger than 4 mm were considered as residual
stones. The dimensions of the stones were calculated
and measured in cm2

. Results thus obtained were
subjected to statistical analysis. P value less than 0.05
was considered significant.

RESULTS
Table I Distribution of patients

Groups Group I Group II Group III
Methods Open stone surgery PNL RIRS
M:F 34 34 34

Table I shows that group I patients underwent open stone surgery, group II patients underwent PNL, and group
III underwent RIRS. Each group had 34 patients.
Table II Assessment of parameters

Parameters Group I Group II Group III P value
Stone burden (cm2

) 3.2 2.5 1.9 0.01
Operative time (mins) 84.2 118.4 78.6 0.001
Length of hospital stay 3.2 3.0 1.4 0.05
Cases with residual stone 9 7 5 0.02
Table II shows that in group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative timein group I was 84.2 minutes, in group II was 118.4 minutes and in group III was
78.6 minutes. There were 9 cases in group I, 7 in group II and group III was 5 cases. The difference was
significant (P< 0.05).
Table III Assessment of complications in groups

Complications Group I Group II Group III P value
Fever 7 4 2 0.02
Infection 2 0 3 0.05
Urine leakage 0 0 5 0.05
Persistent pain 6 1 0 0.001

Table III, graph I shows that there were 7 cases of fever in group I, 4 in group II and 2 in group III, infection 2
in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II. The
difference was significant (P< 0.05).
Graph I: Assessment of complications in groups

0
1
2
3
4
5
6
7

Fever Infection Urine leakage Persistent pain
7

2

0

6

4

0 0

1

2

3

5

0

Group I
Group II
Group III

Haripriya A et al. Treatment of kidney stones.

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Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
DISCUSSION
Currently, a diverse range of non-invasive, minimally
invasive and invasive methods have been reported as
treatment approaches for renal calculi. Recent studies
have reported that flexible ureterorenoscopy
(URS)/holmium laser lithotripsy can be an alternative

treatment for patients with renal calculi. The micro-
percutaneous nephrolithotomy (microperc) is a

recently described technique in which percutaneous
renal access and lithotripsy are performed in a single
step. Microperc has been found to be safe and
effective in removing small renal calculi in the adult
and pediatric populations with a high stone-free rate
and lower complication rate.6 Despite all the new
approaches, shock wave lithotripsy (SWL) remains
the first line treatment modality that is widely used for
renal, ureteral and intermediate-size renal calculi. Its
success rates from contemporary series vary from 60
to 90%. However, during an SWL procedure,
physicians should consider the association between
SWL-related pain and patients’ positioning, which
may negatively affect the SWL success rate as well as
its potential complications. PCNL can be divided into
two types: minimally invasive percutaneous
nephrolithotomy (mini-PCNL) and standard
percutaneous nephrolithotomy (standard PCNL).7
Mini-PCNL has a higher efficacy and better safety in
the management of small renal calculi, while standard
PCNL is still regarded as the conventional technique
for the treatment of large renal stones in the upper
urinary tract. However, in the recent years, there has
been a shift in trend to favor a mini-PCNL approach
in order to reduce the morbidities.8The present study
was conducted to assess efficacy of surgical
techniques and factors affecting residual stone rate in
the treatment of kidney stones.
In present study, group I patients underwent open
stone surgery, group II patients underwent PNL, and
group III underwent RIRS. Each group had 34
patients. Ayedemir et al9

included records of 109
cases of kidney stones. Patients were divided into
three groups in terms of surgical treatment; open stone
surgery, percutaneous nephrolithotomy (PNL) and
retrograde intrarenal surgery (RIRS). Patients’ history,
physical examination, biochemical and radiological
images and operative and postoperative data were
recorded.The patients had undergone PNL (n=74;
67.9%), RIRS (n=22;20.2%), and open renal surgery
(n=13; 11.9%). The mean and median ages of the
patients were 46±9, 41 (21–75) and, 42 (23–67) years,
respectively. The mean stone burden was 2.6±0.7 cm2
in the PNL, 1.4±0.1 cm2 in the RIRS, and 3.1±0.9
cm2 in the open surgery groups. The mean operative
times were 126±24 min in the PNL group, 72±12 min
in the RIRS group and 82±22 min in the open surgery
group. The duration of hospitalisation was 3.1±0.2
days, 1.2±0.3 days and 3.4±1.1 days respectively.
While the RIRS group did not need blood transfusion,
in the PNL group blood transfusions were given in the
PNL (n=18), and open surgery (n=2) groups. Residual

stones were detected in the PNL (n=22), open surgery
(n=2), and RIRS (n=5) groups.
We found that in group I mean stone burden was 3.2
cm2
, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative time in group I was 84.2
minutes, in group II was 118.4 minutes and in group
III was 78.6 minutes. There were 9 cases in group I, 7
in group II and group III was 5 cases. Stone-free rate
in percutaneous nephrolithotomy can vary dependent
on the stone location, and size, as reported in the
literature, it increases up to 90 percent. In the AUA
guideline, this rate has been given as 78 percent. In
our study, in 74 patients, a 70.3% stone-free rate has
been detected. Size, location, composition of the
stone, anatomy of the affected kidney, and experience
of the surgeon are effective on success, and
complications of PNL.10
We found that there were 7 cases of fever in group I, 4
in group II and 2 in group III, infection 2 in group I
and 3 in group III, urine leakage 5 in group III and
persistent pain 6 in group I and 1 in group II.
Lingeman et al11reported 88–91% success rates for
stones with a diameter of 1–3 cm, mean success rate
decreased to 75% in stones larger than 3 cm in
diameter. Still Clayman et al12reported success rates
as 89.2, and 97–100% for stone with a stone burden of
>2, and <2 cm2

, respectively.
CONCLUSION
Authors found that PNL and RIRS have been seen as
safe and effective methods as compared to open
method in case of kidney stones.
REFERENCES
1. Karatag T, Buldu I, Inan R, Istanbulluoglu MO: Is
MicropercutaneousNephrolithotomy Technique Really
Efficacicous for the Treatment of Moderate Size Renal
Calculi? Yes. UrolInt 2015;95:9-14.
2. Kim BS: Recent advancement or less invasive treatment
of percutaneous nephrolithotomy. Korean J Urol
2015;56:614-623.
3. Hyams ES, Munver R, Bird VG, Uberoi J, Shah O:
Flexible ureterorenoscopy and holmium laser lithotripsy
for the management of renal stone burdens that measure
2 to 3 cm: a multi-institutional experience. J Endourol
2010;24:1583-1588.
4. Sabnis RB, Ganesamoni R, Ganpule AP, Mishra S,
Vyas J, Jagtap J, Desai M: Current role of microperc in
the management of small renal calculi. Indian J Urol
2013;29:214-218.
5. Knoll T, Buchholz N, Wendt-Nordahl G: Extracorporeal
shockwave lithotripsy vs. percutaneous nephrolithotomy
vs. flexible ureterorenoscopy for lower-pole stones.
Arab J Urol 2012;10:336-341.
6. Capitanini A, Rosso L, Giannecchini L, Meniconi O,
Cupisti A: Sepsis complicated by brain abscess
following ESWL of a caliceal kidney stone: a case
report. IntBraz J Urol 2016;42:1033-1036.
7. Kim JK, Ha SB, Jeon CH, Oh JJ, Cho SY, Oh SJ, Kim

HH, Jeong CW: Clinical Nomograms to Predict Stone-
Free Rates after Shock-Wave Lithotripsy: Development

and Internal-Validation. PLoS One 2016;11:e0149333.

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8. Kang JH, Lee SW, Moon SH, Sung HH, Choo SH, Han
DH: Relationship Between Patient Position and Pain
Severity During Shock Wave Lithotripsy for Renal
Stones With the MODULITH SLX-F2 Lithotripter: A
Matched Case-Control Study. Korean J Urol
2013;54:531-535.
9. Aydemir H, Budak S, Kumsar Ş, Köse O, Sağlam HS,
Adsan Ö. Efficacy of surgical techniques and factors
affecting residual stone rate in the treatment of kidney
stones. Turkish journal of urology. 2014 Sep;40(3):144.
10. Wong C, Leveillee RJ. Single upper-pole percutaneous
access for treatment of > or = 5-cm complex branched

staghorn calculi: is shockwave lithotripsy necessary? J
Endourol. 2002;16:477–81.
11. Lingeman JE, Coury TA, Newman DM, Kahnoski RJ,
Mertz JH, Mosbaugh PG, et al. Comparison of results
and morbidity of percutaneous nephrostolithotomy and
extracorporeal shock wave lithotripsy. J Urol.
1987;138:485–90.
12. Clayman RV, Mcdougall EM, Nakada SY. Endourology
of the upper urinary tract: percutaneous renal and
ureteral procedures. In: Wals PC, Retik AB, Vaughan
EJ, Wein AJ, editors. Campbell’s urology. Philadelphia:
WB Saunders; 1998; 2789–874.

Imperforate Anus/Absent Anal Opening Treatment Delhi, India
Imperforate anus or absent anal opening, also called anorectal malformation, is a birth defect that happens during the development of baby in early in pregnancy, when the baby is still developing. In this defect, the baby’s anal opening (where stool exits) and the rectum (the last part of the large intestine), do not develop properly, preventing the child from to pass stool.

The condition affects one in 5,000 babies, and it is slightly more common in males than in females. In a baby with anorectal malformation, any of the following can happen:

The anal opening is too small or in the incorrect location
The anal opening is absent and the rectum enters other parts like urethra, the bladder, vestibule or vagina, which can lead to infections and bowel obstruction.
The anal opening may be absent and the rectum, reproductive system, and urologic system form a single common opening called a cloaca, where both urine and stool are passed.
At birth, doctors check the position and size of anal opening. New-borns pass their first stool within 48 hours of birth, so internal malformations are detected quickly. If an issue is found, we do a number of tests to better understand the problems and develop a long-term plan for the best outcome. This problem can be associated with other malformations. Various tests which are performed include:

X-rays of the abdomen to show how far the rectum reaches, and to see if there are any problems with the way the lower backbone has developed.
Abdominal ultrasound to find any problems in kidney.
Spinal ultrasound or MRI to look at the spine for a tethered spinal cord, which can cause neurological problems, such as incontinence and leg weakness as the child grows.
Echocardiogram to find heart defects.
These malformations will always require surgical repair by pediatric surgeon in single or multiple stage, but the exact procedure will depend on the type and severity of the defect, any associated health conditions, and the child’s overall health. Depending on the type and severity these babies may require a stoma formation (a temporary diversion of stools from abdominal wall).

Even though corrective surgery may restore some function, important nerves and muscles that tell your child when the rectum is full of stool and help keep the contents inside may be missing or damaged, so we start a bowel management program when they reach toilet-training to help them become clean.

What is an Undescended Testis?
An undescended testis is a defect that happens before birth when a testicle has still not moved to its correct position, which is the scrotum or the bag of skin hanging below the penis.
This condition usually affects one testicle, but, in a few cases, the condition may effect both testicles, thereby keeping them undescended.
An undescended testis is commonly seen in premature male child.
In most cases, Undescended testis gets recti�ed on its own, as the undescended testis moves to its appropriate position within the �rst few months of life.
However, if this condition is not corrected on its own till 6 months of age, then a surgery is required to move the testicle in to its correct position.

What are the signs or symptoms of an Undescended Testicle
If you cannot see or feel a testicle in the baby’s scrotum, then this may be due to an undescended testicle.
When the foetus is still developing, testicles are formed inside the abdomen.
In normal development of the foetus, the testicles descend from the abdomen, into the scrotum, through the tube-like passage, into the groin (inguinal canal).
The above process, happens in the last couple of months of normal foetal development. When this process is halted or delayed, it leads to the condition called Cryptochordism or Undescended Testicle.

When should you consult a doctor an undescended testicle ?
An undescended testicle gets identi�ed in the post birth examination of the baby boy.
If this happens, the baby boy will need to be examined regularly, and you should check with your doctor on the frequency of the baby boy’s examination.
It is often noticed, that if the testis has not moved to the scrotum within 6 months, chances are, the condition may not get recti�ed on its own.
Getting the baby boy treated for undescended testicle may lower the risk of complications in the future, like testicular cancer and infertility.
Some boys may have been born with normal testicles at birth, but the same might appear missing later. This may happen due to the following reasons:

Retractile Testicle – In this, the testicle moves back and forth, between the scrotum and groin. This may happen due to a muscle reflex in the scrotum, and may be easily guided into the scrotum with the hand, during the physical examination.
Ascending testicle – In this condition, the testicle moves back to the groin and cannot be guided back to the scrotum with the hand. This is also called acquired undescended testicle.
The corrective surgery is orchidopexy means fixing the testis in scrotum. The testis lying inside the abdomen needs laparoscopic orchidopexy.
It is best to speak to your paediatrician or doctor if you see any changes in your son’s genitals or are concerned about his developments.
To book an appointment with Dr. Prashant Jain, the best paediatric surgeon in Delhi, Call (+91) 8766350320.

Risk factors of Undescended Testicles
Factors that might increase the chances of having an undescended testicle are:

Premature birth of the baby boy
Low birth weight of the infant
Complications associated with Undescended Testicles
Testicles need to be cooler than the normal body temperature, so they can develop and function normally. This environment is provided by the scrotum. In case of an incorrect placement of the testicle, following are the complications that may arise:

Testicular Cancer – develops in the cells of the testicles that produce immature sperms. Men with undescended testicles are at a higher risk of having testicular cancer. This risk increases if the testis is located in the abdomen instead of the groin, and when both testicles are affected. While the cause of cells developing into testicular cancer is still unknown, surgical correction may reduce the chances but does not eliminate the risk completely.
Fertility problems – Men with undescended testicles may develop low sperm count, poor quality sperm and reduced fertility the condition is ignored or left untreated for a long time.
Other complications associated with Undescended testicles are:
Testicular Torsion – This condition is painful as it cuts off the blood supply to the testicle. This happens when the spermatic chord, which contains blood vessels, nerves and the tube which carries semen, gets twisted. If left untreated, it may result in the loss of the testicle. Men with Undescended Testicles are ten time more prone to testicular torsion than the ones with normal testicles.
Inguinal Hernia – Happens when a part of the intestine pushes into the groin, if the opening between the abdomen and the inguinal canal is too loose.
Trauma – The testicle may be prone to damage from the pressure against the pubic bone, if it is located in the groin.
To know more or to book an appointment with Dr. Prashant Jain, the best paediatric surgeon in India, Call (+91) 8766350320.

Diagnosis of Undescended Testicle
Doctors may recommend the following types of surgery for the diagnosis and treatment in case of an undescended testicle.

Laparoscopy – Laparoscopy helps �nd out an intra-abdominal testicle. A small incision is made in the abdomen, post which, a small tube containing a camera is inserted.
In some cases, an additional surgery may be needed if the doctor cannot rectify the testicle’s
position during laparoscopy.
In case laparoscopy shows the absence of a testicle or a small remnant of the testicular tissue, then the same is removed.
Open surgery – This type of a surgery, requires a slightly bigger incision when testis is lying in groin.
Post the birth of a boy, if the doctor notices that the boy’s testicles are missing in the scrotum, he may do a few tests to see if the testicles are undescended or are absent.
If left untreated or undiagnosed, absence of testicles may cause serious medical problems post birth.
It is not recommended to go for an ultrasound or an MRI for the diagnosis of an Undescended Testicle.
Treatment of an Undescended Testicle
Treatment helps in moving the undescended testicle in to it’s appropriate position in the scrotum.
It is recommended that surgical intervention happens before 18 months of the child’s age. Earlier the treatment happens, better it may be, as treating the infant before one year, may reduce complications.
Following are the different treatment for Cryptochordism or Undescended Testicle:
Surgery
The process of the surgeon, moving the testicle back into the Scrotum and stitching it to place, is called Orchiopexy. Laparoscopy or surgery is used to carry out this process.
A number of factor’s, such as, the infant’s health or the level of the surgery’s complication, may determine how soon the surgery or correction of the undescended testicle can be carried out.
The surgery may be recommended when the child is between 6-12 months old. Early surgery reduces the risk of complications in the future.
The surgeon removes the tissue, in case he sees that the tissue has not developed properly or is an abnormal or a dead tissue.
The surgery also repairs an Inguinal Hernia that may occur due to the Undescended Testicle.
Post surgery, the testicles are regularly monitored to con�rm if it is staying in place and is developing properly. This is done through physical exams, Ultrasound examination of the scrotum and by testing of hormonal levels.

Other Treatments
Saline Testicular Prosthesis treatment, which gives the scrotum a normal appearance, may be considered, if one or both testicles are missing or did not survive post surgery.
An Endocrinologist or a hormone specialist may be referred if the child does not have even one testicle which is healthy.
Endocrinologist helps with future hormone treatments that are necessary to bring about puberty and physical maturity.
Results
Orchiopexy, mostly has a 100% success rate. Post surgery, the fertility for males with Undescended Testicle is nearly normal, however, for males with two Undescended Testicles, the chances are 65%.
While surgery might reduce the risk of testicular cancer, it still does not eliminate it.

Lifestyle changes and remedies at home for Undescended Testicles:
It is important to ensure that the testicles are developing normally, even after the child’s surgery. Being aware of the development of your son’s body and checking the position of his testicles regularly, helps him in the long run. This can be done while changing the diaper or while bathing him.
Talk to your son about the physical changes that are about to happen, when he reaches puberty.
Teach and encourage him to check his testicles regularly, as self-examination can help with the early detection of tumors.
How to cope with and support your son with Undescended Testicle Your son may be uneasy or sensitive about looking different, especially if he has to change his clothes in front of his friends or classmates, in a sports or in a school drama changing room. Guide him with the following tips, to help him deal with anxiety

Practice him to come up with a response if he is asked or teased about his condition
Let your son know that he is healthy, even if one or both the testicles are missing, and that there are two testicles in the scrotum
Teach your son to use the right words when he is talking about testicles or scrotum
To make the condition less noticeable, let your son wear loose-�tted swimming trunks or boxer shorts, so he is comfortable while changing clothes in front of others
Be watchful or aware of any behavioural changes, like not enjoying the sports or activities he he earlier used to
Speak to him about testicular prosthesis and discuss if it is a good option for him
What to ask your doctor if your son has undescended testicles
An undescended testicle is a birth defect, and is identi�ed in the post birth examination. This condition is monitored through regular examination of your infant. Here are a few questions that you can ask your family doctor or your paediatrician:

What are the different tests that my son will need to undergo?
Which option would you recommend as a treatment?
Can you recommend a specialist, to whom i can show my son’s condition.
to build my knowledge about my son’s condition, can you recommend a few websites or give me some brochures that i can read at home
How frequent should my son’s appointments be?
To monitor any changes in the undescended testicle, how can i examine the scrotum at home?

Fractional Laser Resurfacing

What is fractional resurfacing?
Fractional resurfacing is an advanced technology in which only a small fraction of the skin receives the laser light. The laser delivers a series of high precision microbeams that create narrow, deep columns of tissue penetration well below the epidermis (skin surface) and into the dermis, while preserving the surrounding healthy tissue from damage. This “fractional� treatment allows the skin to heal much faster than if the entire area were treated at once, using the body’s natural healing process to create new, healthy skin cells.

What conditions does fractional resurfacing treat?
Fractional resurfacing is very effective on fine lines and wrinkles (including around the eyes), age or sun spots, acne scars, surgical scars and sun damage.

What is the recovery time?
The healthy cells in unlasered areas promote rapid healing of the entire treatment area, resulting in faster recovery time and minimal side effects. The result is softer, smoother and healthier skin without a prolonged healing period.

Vesicoureteric Reflux
Vesicoureteral Reflux Causes, Symptoms And Treatments
Kidneys are important organ for urine formation. Normally, urine flows into the bladder through ureters. However, in some children, urine from the bladder flows back through the ureters. This condition is known as Vesicouretral reflux (VUR) and is common in infants and children. It can be unilateral or bilateral. This could cause infections and damage your kidneys. VUR affects about 10% of children. Although most can grow out of this condition, people who have severe cases may need surgery to protect their kidneys.

This condition should not be ignored as it damages the function of kidneys and can lead to high blood pressure later in life. The risk of kidney damage is greatest during the first 6 years of life.

Causes of VUR:
A flap valve is located where the ureter joins with the bladder. Usually, the valve allows only a one-way flow of urine from the ureters to the bladder. Sometımes, a defective flap valve allows urine to flow backward. This can affect one or both ureters. This is called “primary vesicoureteral reflux.�

Sometimes VUR can be because of blockage at the bladder outlet(Posterior urethral valve or abnormality of the bladder functions (Neurogenic bladder) that can causes urine to push back into the ureters.

This back flow of urine is responsible for recurrent urinary tract infections and damage of kidney (Renal scarring).

Symptoms:
Urinary tract infection is one of the commonest presentation seen in children younger than the age of 5.

Common symptoms are:

Foul smelling or cloudy urine
Fever
Burning or pain while urinating
Frequency and urgency of urine
Vomiting

Infants may have following symptoms.

Diarrhoea.
Poor feeding.
Fever
Increased irritability
Also ultrasound scan done during pregnancy showing swelling in kidneys can be because of VUR.

Diagnosis Of VUR:
VUR can often be suspected by ultrasound before a child is born or if child has urinary tract infection. Ultrasound may show dilatation of drainage system of kidney (Pelvi-calyceal system and ureter) called as hydronephrosis, but this does not prove that reflux is present.

VUR is diagnosed using an X-ray of the bladder known as voiding cystourethrogram (VCUG). In this procedure, a thin, soft tube (catheter) is placed in the bladder through the urethra. Dye is then introduced into the bladder through the tube. X-ray pictures are taken to see if the dye flows back into the ureters. Based upon the severity, VUR is categorized into five grades. Milder grade of VUR does not require any treatment. All infants with urinary tract infection and other older children with frequent urinary tract infections with or without hydronephrosis should a be considered for VCUG test.

Treatment Options For Management Of VUR:
There are 3 main options for managing or treating VUR. One should understand the risks, benefits, and follow-up of each treatment.

Antibiotic: It is used to prevent infections until VUR goes away by itself. This treatment may take several years, and children must take medication every day. These children need to be reassessed for VUR and renal damage on regular basis. However, long term treatment with antibiotics may cause the bacteria to become resistant, increasing the risks of recurrent infections.

Surgery: This type of treatment cures most children. Surgery is good option for high grade reflux. This can be performed by open or laparoscopic technique.

Endoscopic treatment (Deflux Injection): In this day care procedure, the medication is injected where the ureter joins the bladder. Deflux is a safe and effective treatment for VUR. A gel is introduced into the body where the ureters meet the bladder. This procedure is performed as a day care procedure. Deflux gel is placed at the spot where the ureters connect to the bladder with the help of a small camera called a cystoscope (a type of endoscope used to view the bladder). Eventually, new tissue grows around the gel, preventing the reflux of urine. Usually, there will be no pain after the procedure. Deflux is used for the treatment of all grades of VUR in children. Many children have success after one injection; while some may need more injection procedures. However lower the grade of VUR, the better it works. Also, the procedure works better for children who have reflux in only one ureter.