What is vesicoureteral reflux?

The urinary system is made up of two kidneys, two ureters, the bladder and a urethra. The kidneys are the bean-shaped structures located just below the rib cage that make urine and filter waste products from the blood. The ureters are thin tubes that carry the urine from the kidneys to the bladder where it is stored until leaving the body. The urethra is the tube that carries urine from the bladder out of the body.

Vesicoureteral reflux (VUR) occurs when urine in the bladder flows backward or “refluxes” into the ureters and kidneys. Because of this reverse urine flow, a child with VUR is at higher risk for kidney infections due to bacteria that may be present in the urine. Reflux is measured or graded on a scale of 1 (mild) to 5 (severe).

Causes of VUR

VUR can be present at birth (congenital) or develop later in life (acquired). Congenital VUR is caused by an abnormal insertion of the ureter into the bladder which allows upward flow of urine. VUR that develops after birth, or is acquired, is caused by abnormal bladder function.

Symptoms

• Urinary tract infection with fever
• Hydronephrosis (kidney swelling due to build-up of urine) or abnormalities found on a kidney ultrasound

Testing and diagnosis

A voiding cystourethrogram (VCUG) is typically performed to evaluate for VUR. During this test, the bladder is filled with dye through a thin, plastic tube (or catheter) placed in the urethra and x-rays are taken. VUR is present if the dye is visible in the ureters or kidneys on the x-ray.

Treatment

Most children will outgrow mild to moderate VUR on their own. Some may be managed with low-dose daily antibiotics and frequent ultrasounds (painless test that takes pictures of the kidneys) to monitor kidney growth, any swelling (dilation) or scarring. Children with more severe reflux, recurrent urinary tract infections or reflux that does not resolve may require surgical intervention.

Treatment for VUR may vary based on:

• Child’s age, overall health and medical history
• Grade of reflux and the frequency and severity of urinary tract infections
• Child’s tolerance for necessary medications, tests or treatments

A treatment plan will be determined with your child’s urology team based on your child’s individual needs.