Vesicoureteral Reflux

Vesicoureteral reflux is a structural or congenital condition

Normally, urine travels from the kidneys to the bladder and out of the body. When this process is reversed and urine goes back into the kidneys, it’s a condition referred to as vesicoureteral reflux (VUR). More likely to occur in children and infants, VUR increases the risk of recurring urinary tract infections and damage to the kidneys.

Some children outgrow the condition.
If this doesn’t happen, treatment usually involves medication or surgery.

Types of VUR and Causes

Ureters transport urine from kidneys to bladder

A valve mechanism prevents urine from moving backward

Structural or nerve-related issues can disrupt this system

Tubes called ureters take urine from the kidneys to the bladder for storage. When the bladder is full, urine passes through another tube called the urethra to the outside of the body. A muscle-valve created due to the way the ureter works its way through the bladder wall prevents urine from traveling back up to the kidneys.

Primary and Secondary Vesicoureteral Reflux

Two main types of VUR can interfere with the normal flow of urine. These types are classified based on the underlying cause of the reflux.

Primary VUR occurs when a defect present at birth prevents the valve that normally stops back-flow from fully forming.

Secondary VUR develops when nerve damage or bladder muscle problems prevent the bladder from fully emptying.

Bladder and bowel dysfunction may contribute to the development of reflux. A family history of VUR can also increase the likelihood of the condition.

Symptoms and Signs Associated with VUR

Urinary tract infections are usually the first sign that urine is traveling back into the kidneys. Children with VUR may urinate more frequently, feel a burning sensation when urinating, or feel pain on their sides or in their abdominal area. Signs of vesicoureteral reflux may also include:

Cloudy or odorous urine

Blood in urine

Diarrhea

Appetite changes

Fever

High blood pressure

An abdominal mass from kidney swelling

Signs of kidney failure

How It’s Diagnosed

Sonography may be used to produce images of the bladder and kidneys

A voiding cystourethrogram compares X-ray images of a full and empty bladder

A radionuclide cystogram evaluates the urinary tract using a radioactive tracer

A catheter may be used to deliver the tracer during the exam

After an initial exam, a urinalysis is usually done to look for chemical imbalances suggesting urine backup. Imaging tests are often used to evaluate the urinary tract and kidneys.

Treatment Options for VUR

Non-Surgical Management

Periodic observation may be recommended for mild VUR. If symptoms become more severe, antibiotics are usually prescribed. Children may receive low-dose antibiotics even when no infection is present to prevent recurring UTIs.

Surgical Treatment

If reverse urine flow is causing serious problems, surgery may be necessary. Traditional open surgery corrects the defect through an abdominal incision, while robotic-assisted laparoscopic surgery uses smaller incisions. Endoscopic procedures may involve injecting a bulking agent through a cystoscope to strengthen the valve.

Evaluation for Persistent Symptoms

If the condition develops in older children, the most noticeable symptom may be bedwetting (nocturnal enuresis). Should a pediatrician rule out common causes of bedwetting, a referral may be made to a urologist to thoroughly examine the urinary tract, connecting tubes, and kidneys for signs of vesicoureteral reflux.