Vesicoureteral Reflux

What is vesicoureteral reflux (VUR)?

Vesicoureteral reflux occurs when urine dwelling in the bladder flows back into the ureters and often back into the kidneys. The bladder is the hollow, muscular organ that stores urine before urination occurs. The bladder has three small openings; two connect the ureters where urine is drained down from the kidneys, and one connects the bladder to the urethra where urine exits the body.
The ureters are funnel-shaped tubes that carry urine from the kidneys. Ureters enter the bladder at a diagonal angle and have a special one-way valve system that normally prevents urine from flowing back up the ureters in the direction of the kidneys. When a child has vesicoureteral reflux, the mechanism that prevents the back-flow of urine does not work, allowing urine to flow in both directions. This condition is most frequently diagnosed in infancy and childhood. A child who has vesicoureteral reflux is at risk for developing recurrent kidney infections, which, over time, can cause damage and scarring to the kidneys.

What causes vesicoureteral reflux?

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

•    VUR commonly occurs in children whose parents or siblings have the irregularity.
•    Children who are born with neural tube defects such as spina bifida may have VUR.
•    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, the irregularity is more common in girls.
•    VUR can occur in children with other urinary tract abnormalities such as posterior urethral valves, ureterocele, or ureter duplication.
•    VUR is more common in Caucasian children than in African-American children.

Treatment for vesicoureteral reflux:

VUR can occur 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 infection(s) and permanent kidney damage. Specific treatment for VUR will be determined by your child’s physician based on:

•    your child’s age, overall health, and medical history
•    the extent of the condition
•    your child’s tolerance for specific medications, procedures, or therapies
•    expectations for the course of the condition
•    your opinion or preference

Your child’s physician 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 3 VUR do not need any type of intense therapy. The reflux resolves on its own over time, usually within five years. Children who develop frequent fevers or infections may require ongoing preventative antibiotic therapy and periodic urine tests.
Children who have grade 4 and 5 reflux may require surgical intervention. During the procedure, the surgeon will create a flap-valve apparatus 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, in some cases, for vesicoureteral reflux. Consult your child’s physician for more information.