Vesicouereteral Reflux Case Powerpoint Presentation

Vesicouereteral Reflux Case Powerpoint Presentation

1. Pediatric Vesicourethral Reflux

2. Case Presentation 01

3. Patient Profile: Charbel, a 2-year and 7-month-old previously healthy boy, was presented to the ER for evaluation of fever. There was no past medical or surgical history but a  positive maternal history of vesicoureteral reflux (VUR) . Initial investigations revealed: CRP:  113 WBC:  18 x10⁹/L CO2:  18 Creatinine:  0.39 Urinalysis:  Numerous WBCs Urine and blood cultures  were sent The patient was  diagnosed with a urinary tract infection (UTI)  and received his  first dose of IV Rocephin in the ER , followed by admission for continued management. The abdomen was soft and non-tender; he tolerated feeds and remained clinically stable.

4. Management: The patient was started on intravenous Rocephin upon diagnosis of UTI. Supportive care with IV fluids was provided, and vitals were closely monitored. Pantoprazole 16mg IV OD Rocephin resistant + CRP very high  Meronem 40 mg/kg/dose + Amikacin 15 mg/kg/dose double therapy IV Q8 hours, then Meronem alone Perfalgan 240 mg IV as antipyretic

5. Clinical course: Clinical Course Fever Vomiting Urine Stool Day 1 2 episodes 1 episode Dark and unpleasant odor good Day 2 2 episodes No E. Coli good Day 3 2 but far apart No good Day 4 1 No good Day 5 N o fever No good

6. Clinical course: Clinical Course Fever Vomiting Urine Stool Day 6 No No constipation Day 7 No No Constipation for 72 hours ( glycerine was given) Day 8 No No good Day 9 No No Sterile good

7. Management: In light of his mother’s history of VUR, and given his presentation, a  voiding cystourethrogram (VCUG)  was also performed.

8. Imaging Results and Diagnosis

9. Imaging Results and Diagnosis

10. Imaging Results and Diagnosis: VCUG  revealed  Grade IV Vesicoureteral Reflux (VUR) . This explained the potentially severe UTI episode. urination was observed to rule out urethral obstruction or posterior urethral valves (PUV)

11. Discharge Plan: Patient was discharged on Bactrim 40 mg TMP/SMX 200 (10 mg/kg/day) for 1 week as a continued treatment. Prophylactic plan to be discussed with nephrologist

12. Discussion 02

13. Vesicoureteral 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 . Patients with VUR demonstrate a wide range of severity, and most reflux patients will not develop renal scars & will not need any intervention. At presentation,  VUR  can range from mild to severe.

14. Epidemiology & Statistics Many children with VUR have NO symptoms of UTI, and invasive diagnostic procedures are performed  only when clinically indicated ; therefore, the exact prevalence of VUR is unknown. The  prevalence  of VUR in  normal children  has been estimated at  0.4–1.8% . Among infants prenatally identified by ultrasonography to have hydronephrosis &  screened for VUR, the  prevalence  was  16.2% . Siblings of children with VUR had a  27.4%  (range: 3–51%) risk of also having VUR, whereas the offspring of parents with VUR had a higher incidence,  35.7%.

15. Context Embryology & Pathogenesis VUR Pathogenesis : Abnormal ureteral bud positioning → ectopic ureteral orifice → short intramural ureter → VUR. Normal ureteral tunnel ratio: 5:1 ( length:diameter ); refluxing UVJs: 1.4:1. Ureter arises from mesonephric (Wolffian) duct. Trigone derives from bladder smooth muscle.

16. Risk Factors for VUR in Children

17. Grading of VUR

18. Grading of VUR

19. Diagnostic Workup

20. Conservative Management Ultimate Goal : Prevent febrile UTIs. Indications : Low-grade reflux (Grade I-III), normal kidneys, no LUTD. Approaches : Watchful waiting, Continuous antibiotic prophylaxis (CAP), Bladder rehabilitation for LUTD. Monitoring : Biannual ultrasound, annual VCUG/DMSA as needed.

21. Indications for Intervention Breakthrough febrile UTIs despite CAP. Persistent high-grade reflux (Grade IV/V). Bilateral high-grade reflux. Abnormal renal parenchyma or recurrent infections. Parental preference for definitive treatment.

22. Surgical Management Options Subureteral Injection of Bulking Agents : Endoscopic; Minimally invasive, Common agents: Deflux ( dextranomer /hyaluronic acid). Open Ureteral Reimplantation : High success rate (92-98%), Cohen cross-trigonal, Politano-Leadbetter, Lich-Gregoir techniques. Laparoscopic Approach : Comparable outcomes to open surgery, Longer operative times, more invasive than endoscopy. Robotic-Assisted Approach : Remains under development...

23. Endoscopic VUR Repair Minimally invasive, outpatient. Bulking agent injection under ureteral orifice. Success rate: 83% (95% CI: 69.1-91.4). Adopted Technique : STING technique ( Subureteric Teflon Injection ):First described in 1984. HIT technique ( Hydrodistention Implantation Technique ): Injects into ureteral tunnel, creating 'mountain range' appearance. Ideal Bulking Agent Qualities : Durable, non-migrating, biocompatible. FDA-approved Deflux ( dextranomer /hyaluronic acid). Endoscopic VUR Repair

24. Open VUR Repair Ultimate Goal : Lengthen intravesical ureter to create anti-reflux mechanism. Success Rate: 98.1% (95% CI: 95.1-99.1). Extravesical Approach  (Lich-Gregoir): No bladder opening. Risk: Pelvic nerve damage, urinary retention (bilateral cases). Intravesical Approaches : Politano-Leadbetter: New ureteral tunnel. Glenn-Anderson: Submucosal tunnel towards bladder neck. Cohen: Ureter crosses bladder floor to contralateral side. Risks: Hematuria, ureteral kinking, bowel injury.

25. Laparoscopic VUR Repair Less invasive alternative to open surgery. Success rates: 88-100%. Benefits :  Shorter Hospital Stay Smaller Incisions Quicker Recovery. Downsides :  Technically Demanding Longer OR Time Higher Risk of Ureteral Injury Urine Leak Fistulas

26. Outline the research design for the medical breakthrough. Describe the type of study, sample size, inclusion criteria and ethical considerations Explain the methods and tools used for data collection, including patient records or examinations. Emphasize data accuracy and patient privacy Describe the approach for analyzing the collected data. Explain the statistical methods or qualitative analysis techniques used to derive meaningful insights Discuss the steps taken to validate the results. Explain how the findings will be reviewed, confirmed or peer-reviewed for scientific rigor Methodology Study design Data analysis Data collection Results validation

27. Regular imaging (ultrasound, VCUG, DMSA). Monitor kidney growth and function. Reassess LUTD symptoms. Educate families on UTI signs, importance of follow-up. Conclusion and Recommendations In conclusion, VUR management requires individualized risk assessment. A balance between avoiding overtreatment and preventing renal damage.A multidisciplinary approach focusing on collaborations (urologist, nephrologist, pediatrician) essential for optimal outcomes.

28. Data and statistics Key performance indicato r Number Patients treated 2,500 Success rate 95% Average recovery time 3 days Trend in patient outcomes Follow the link in the graph to modify its data and then paste the new one here. For more info, click here List the key performance indicators (KPIs) relevant to the medical breakthrough Enter the values or metrics for each KPI in the table Discuss the significance of each KPI and its relation to the breakthrough Highlight any notable achievements or milestones reflected in the table Illustrate the trend in patient outcomes over time Highlight the impact of the medical breakthrough on patient outcomes Describe any significant changes or improvements observed in the graph

29. THANK YOU!

30. Results and conclusions Background Briefly introduce the context of the investigation, such as the medical condition or problem being addressed and the goals Study design Describe the design of the study, such as whether it was a randomized controlled trial or observational study, the sample size and the inclusion and exclusion criteria Findings Summarize the main findings of the investigation, including statistical results and any important trends or patterns observed Impact Discuss the implications of the findings for patients, healthcare providers and other stakeholders. References Include a reference page with the sources used in your presentation. List the sources in alphabetical order and include the author's name, the title of the source, the publication date and the publisher or URL Conclusions Briefly summarize the main findings of the study or analysis Discuss the implications of the findings and how they relate to the original research question 1 2

31. Alternative resources Here’s an assortment of alternative resources whose style fits that of this template: Flat illustration for world kidney day Gradient urology illustration