Vesicoureteral Reflux (VUR)

What is vesicoureteral reflux?

Vesicoureteral reflux (VUR) is a condition where urine in the bladder flows backward into tubes called ureters and often back into the kidneys.

Normally urine flows in one direction. It flows down from the kidneys through the ureters to the bladder. The bladder is the organ that stores urine before urination happens. The bladder has 3 small openings. Two openings at the top connect the bladder to the ureters. One opening at the bottom connects the bladder to the urethra, where urine exits the body.

The ureters have a special 1-way valve system that normally stops urine from flowing back up to the kidneys. When a child has vesicoureteral reflux, this valve system doesn’t work. Urine can then flow backward (reflux) into the ureters and may enter the kidneys.

This condition is most often diagnosed in infancy and childhood. A child who has VUR is at risk for developing recurrent kidney infections. Over time this can cause damage and scarring to the kidneys.

What causes vesicoureteral reflux?

There are many different reasons why a child may develop VUR. Some of the more common causes include:

• Having parents or siblings with VUR

• Being born with neural tube defects like spina bifida

• Having other urinary tract abnormalities, like posterior urethral valves, ureterocele, or ureter duplication

During infancy, the disease is more common among boys because as they urinate there is more pressure in their entire urinary tract. In early childhood, VUR is more common in girls. It is more common in white children than in African-American children.

What are the symptoms of vesicoureteral reflux?

The following are the most common symptoms of vesicoureteral reflux. However, each child may experience symptoms differently. Symptoms may include:

• Urinary tract infection. Symptoms of a UTI may include burning or pain with urination, frequent urination, fever, and back pain. These symptoms are unlikely in boys at any age, unless VUR is present.

• Trouble with urination including:

  • Urgency

  • Dribbling

  • Wetting pants

• A stomach mass from a swollen kidney

• Poor weight gain

• High blood pressure

The symptoms of VUR may look like other conditions or medical problems. Always talk with your child's healthcare provider for a diagnosis.

How is vesicoureteral reflux diagnosed?

VUR can often be found by ultrasound before a child is born. Sometimes there may be a family history of VUR, but the child has no symptoms. In those cases the healthcare provider may choose to do a diagnostic test to rule out VUR. Diagnostic tests for VUR may include:

• Voiding cystourethrogram (VCUG). A VCUG is a specific X-ray that examines the urinary tract. A hollow tube (catheter) is placed in the urethra. This tube drains urine from the bladder to the outside of the body. The bladder is filled with a liquid dye. X-ray images will be taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.

• Renal ultrasound. This is a noninvasive test. A probe (transducer) is passed over the kidney on the outside of the body. It makes sound waves that bounce off the kidney and transmit a picture of the organ onto a video screen. The test is used to figure out the size and shape of the kidney. It can also find a mass, kidney stone, cyst, or other blockages or abnormalities.

What is the treatment for vesicoureteral reflux?

VUR can happen in varying degrees of severity. It can cause mild reflux, when urine backs up only a short distance in the ureters. Or it can cause severe reflux leading to kidney infections and permanent kidney damage.

Your child's healthcare provider will figure out the best treatment plan for your child based on:

• Your child’s age, overall health, and medical history

• How sick your child is

• How well your child handles certain medicines, treatments, or therapies

• If your child’s condition is expected to get worse

• The opinion of the healthcare providers involved in your child's care

• Your opinion and preference

Your child's healthcare provider may assign a grading system (ranging from 1 to 5) to indicate the degree of reflux your child has. The higher the grade, the more severe the reflux.

Most children who have grade 1 through grade 3 VUR don’t need any type of intense therapy. The reflux goes away on its own over time, usually within 5 years. Children who develop frequent fevers or infections may need ongoing preventive antibiotic therapy and periodic urine tests. Surgical treatment is also available.

Children who have grade 4 and grade 5 reflux may need surgery. During the procedure, the surgeon will create a flap-valve device for the ureter that will prevent reverse flow of urine into the kidney. In more severe cases, the scarred kidney and ureter may need to be surgically removed.

New treatments are being introduced for VUR. Talk with your child's healthcare provider for more information.