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Vesicoureteral Reflux—Adult by Sonja Lyons

Definition

Vesicoureteral reflux (VUR) is the backward flow of urine. The urine flows from the bladder back into the kidney.

Urine normally flows from the kidneys. It passes through tubes called ureters. It then flows into the bladder. Each ureter connects to the bladder in a way that prevents urine from flowing back up the ureter. The connection is similar to a one-way valve. When this does not work properly, or if the ureters do not extend far enough into the bladder, urine may flow back up to the kidney. If the urine contains bacteria, the kidney may become infected. The back-up can also put extra pressure on the kidney. This can cause kidney damage.

This is a potentially serious condition that requires care from a doctor. Early treatment and prevention of infections can lead to better outcomes. If you suspect you have this condition, contact your doctor immediately.

Anatomy of the Urinary System

Causes

This condition may be caused by:

A problem in the way the ureter inserts into the bladder
A ureter that does not extend far enough into the bladder
A bladder outlet obstruction (eg, blockage of urine flow from an enlarged prostate gland)
A neurogenic bladder (loss of normal bladder function due to damaged nerves reaching the bladder)
Temporary swelling after kidney transplant

Risk Factors

Factors that increase your chance of developing VUR include:

Family history
Congenital abnormalities of the urinary tract
Birth defects that affect the spinal cord, such as spina bifida
Tumors in the spinal cord or pelvis
Spinal cord injury

Symptoms

In most cases, VUR has no obvious symptoms or signs. In some cases, VUR is found after a urinary tract or kidney infection is diagnosed. Symptoms of urinary tract infections include:

Frequent and urgent need to urinate
Passing small amounts of urine
Pain in the abdomen or pelvic area
Burning sensation during urination
Cloudy, bad-smelling urine
Increased need to get up at night to urinate
Blood in the urine
Leaking urine
Low back pain or pain along the side of the ribs
Fever and chills

A prenatal ultrasound may show a swelling of the kidneys. This is called hydronephrosis . It may indicate VUR.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:

Blood tests
Urine tests
Ultrasound
CT scan
Voiding cystourethrogram (VCUG)—a liquid that can be seen on x-rays is placed in the bladder through a catheter; x-rays are taken when the bladder is filled and when urinating.
Intravenous pyelogram—a liquid that can be seen on x-rays is injected into a vein; x-ray images are taken as the liquid travels from the blood (after being injected into a vein) into the kidneys and bladder
Nuclear scans—a variety of tests using radioactive materials injected into a vein or the bladder to show how well the urinary system is working

In rare cases, high blood pressure may be an indication of kidney damage.

Treatment

The goal for treatment of VUR is to prevent any permanent kidney damage. Treatment options include the following:

Surgery

Endoscopic Injection Into the Ureter

This procedure is a minimally invasive surgery. It is done to correct the reflux. A gel is injected where the ureter inserts into the bladder. This can prevent urine from going back up the ureter. This procedure is done through a small tube called a cystoscope .

Ureteral Reimplantation

This is a surgery that repositions the ureters in the bladder. This can be done in two ways. One way requires making an incision above the pubic bone and repositioning the ureters in the bladder. It can also be done laparoscopically by inserting cameras through small incisions in the abdomen and/or bladder to perform the surgery.

Prevention

VUR cannot be prevented in most cases. However, further complications can be avoided. Seek prompt treatment for bladder or kidney infections. This is particularly important if you have a neurogenic bladder.

RESOURCES:

American Urological Association Foundation http://www.urologyhealth.org/
National Kidney Foundation http://www.kidney.org/

CANADIAN RESOURCES:

Health Canada http://www.hc-sc.gc.ca
The Kidney Foundation of Canada http://www.kidney.ca/

References:

Valla JS, Steyaert H, Griffin SJ, et al. Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: a single-centre 5-year experience. J Pediatr Urol . 2009;5(6):466-471.
Vesicoureteral reflux. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 26, 2012. Accessed October 18, 2012.
Vesicoureteral reflux. National Kidney and Urological Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/vesicoureteralreflux/ . Updated September 2011. Accessed October 18, 2012.
Wein A, ed. Campbell-Walsh Urology . 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007.

Last reviewed October 2012 by Adrienne Carmack, MD

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