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Vesicoureteral Reflux—Child by Sonja Lyons Rebecca J. Stahl, MA

Definition

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

Urine normally flows out 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. This 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. It requires care from a doctor. Early treatment and prevention of infections can lead to better outcomes. If you suspect your child has this condition, call the doctor right away.

The Urinary Tract

Causes

Common causes of VUR include:

A problem in the way the ureter inserts into the bladder
A ureter that does not extend far enough into the bladder
Neurogenic bladder (loss of normal bladder function due to damaged nerves reaching the bladder)

Risk Factors

The following factors increase your child’s chance of developing VUR:

Family history (especially if a sibling or parent has VUR)
Birth defects that affect the urinary tract
Birth defects that affect the spinal cord, such as spina bifida
Tumors in the spinal cord or pelvis
Ethnicity: Caucasian

Symptoms

Your child may not have any symptoms. 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

Diagnosis

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Tests may include:

Blood tests—to assess how well the kidneys are functioning
Urine tests—to look for evidence of an infection or damage to the kidneys
Ultrasound —a test that uses sound waves to examine the kidney and bladder
CT scan —a type of x-ray that uses computers to make pictures of structures in the body
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
Radionuclide cystogram (RNC)—a test like VCUG, but uses a different kind of liquid to obtain images
Intravenous pyelogram —also uses a liquid that can be seen on x-rays; images are taken as the substance 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

The doctor will grade your child’s condition. The grading scale ranges from 1 (mild) to 5 (severe).

Treatment

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

Monitoring

If your child’s condition is graded 1-3, he may not need treatment right away. VUR may go away on its own as the ureters develop. The doctor will monitor your child’s condition. This may include:

Preventive antibiotics—Your child may need to take a low-dose antibiotic every day to prevent infection if your child is having many infections.
Tests to check how the kidneys are functioning

Children are advised to stay well-hydrated by drinking plenty of fluids. They should also empty their bladders frequently.

Surgery

In most cases, surgery is not needed. If your child does need surgery, the options include:

Ureteral reimplantation surgery—This can be done in two ways. One requires making an incision above the pubic bone and repositioning the ureters in the bladder. It can also be done laparoscopically, with cameras being inserted through small incisions in the abdomen and/or bladder to do the surgery.
Endoscopic injection into the ureter—This is a minimally invasive surgery that is done to correct the reflux. A gel is injected where the ureter inserts into the bladder. This can block urine from flowing back up the ureter.

Prevention

VUR cannot be prevented in most cases. You can help your child avoid complications by calling the doctor right away if you think she has a bladder or kidney infection.

RESOURCES:

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

CANADIAN RESOURCES:

BC Health Guide http://www.bchealthguide.org/
The Kidney Foundation of Canada: British Columbia Branch http://www.kidney.bc.ca/

References:

DynaMed Editorial Team. Vesicoureteral reflux. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 2010. Accessed July 13, 2010.
Children’s Hospital Boston. Vesicoureteral reflux. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site1962/mainpageS1962P0.html . Accessed June 29, 2010.
Cincinnati Children’s. Vesicoureteral reflux (VUR). Cincinnati Children’s website. Available at: http://www.cincinnatichildrens.org/health/info/urinary/diagnose/vesicoureteral-reflux.htm . Accessed June 29, 2010.
Lyons S. Vesicoureteral reflux. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 30, 2009. Accessed June 29, 2010.
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):466-71.

Last reviewed June 2012 by Kari Kassir, MD

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Vesicoureteral Reflux—Child by Sonja LyonsRebecca J. Stahl, MA