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Pediatric Urology

Vesicoureteral Reflux

What is vesicoureteral reflux (VUR)?

Urine is made by the kidneys and flows down tubes called ureters to the bladder, where it is stored until urination occurs.  During normal voiding, the bladder contracts as the pelvic sphincter muscles relax, allowing urine to leave the bladder through a tube called the urethra

Vesicoureteral reflux occurs when this normal flow of urine is reversed and, instead, urine backs up into the ureters and the kidneys. 

Ureters enter the bladder at a diagonal angle and have a special one-way "valve" that normally prevents urine from flowing back up into the kidneys.  However, this "valve" does not work properly in children diagnosed with VUR, so urine is able to flow in both directions.  Because of reverse urine flow, a child who has vesicoureteral reflux is at higher risk for bacteria that may be present in the urine to infect the kidneys, which can cause long-term damage and scarring to the kidneys. Risk factors associated with VUR include:

Children whose parents or siblings also have VUR.Children born with neural tube defects, such as spina bifida.During infancy, VUR is more common among boys because there is more pressure created in their urinary tract with urination.  In early childhood, VUR tends to be more common in girls.Children who have other urinary tract abnormalities, such as posterior urethral valves, ureter duplication, or multicystic kidney.

Caucasian children tend to be affected more frequently than African-American children.

What are the symptoms of vesicoureteral reflux?

Each child may experience symptoms of VUR differently.  The most common symptoms include:

Urinary tract infection (urinary tract infections are uncommon in children younger than 5 years of age and unlikely in boys at any age)

Trouble with urinating, such as urgency, leaking, frequency, or urine accidents

Painful urination

Poor weight gain

How is vesicoureteral reflux diagnosed?

VUR can sometimes be detected on prenatal ultrasound before a child is born. If your child has symptoms of VUR or if there is a family history of VUR, diagnostic tests to rule out VUR may include:

Renal Ultrasound:  A non-invasive test in which a transducer is placed over the kidney and a picture of the organ is transmitted to a video screen.  This test can evaluate the size and shape of the kidney and also can detect other abnormalities, such as masses, kidney stones, and cysts.

Voiding Cystourethrogram (VCUG): A set of x-rays to examine the urinary tract while the bladder fills and empties.  The images will indicate if there is any reverse flow of urine up into the kidneys.

Blood tests:  Occasionally, some specific blood tests may be needed to determine kidney function.

Treatment for vesicoureteral reflux:

VUR can occur in varying degrees of severity and is measured or graded on a scale of 1 to 5.  VUR is considered to be mild (Grade 1-2) if urine backs up only a very short distance into the ureters.  Or, VUR can be severe (Grade 4-5) and lead to multiple kidney infections and permanent kidney damage.

Specific treatment will be based on:

  • child's age, overall health, and medical history
  • severity of the reflux
  • child's tolerance for specific medications, procedures, or therapies
  • expectations for the course of treatment
  • parent's preferences and opinions

Many children will outgrow the condition on their own.  In the meantime, most children with reflux can be managed with antibiotics and surveillance through periodic ultrasounds and VCUG tests.  Children with mild or low-grade VUR may not require surgical intervention, but will need preventative antibiotic treatment.  Children with more severe reflux may require surgical intervention to correct the reverse flow of urine into the kidney and prevent future kidney damage.


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updated: April 18, 2017