Vesicoureteral Reflux

Vesicoureteral reflux is a condition in which urine flows backward from the bladder into the kidneys.

With vesicoureteral reflux (VUR), the urine flows backward through tubes, known as ureters, which are meant to carry urine forward into the bladder as it exits the kidneys. Under normal circumstances, urine is prevented from flowing back into the kidneys by the bladder muscles as they put pressure on the ureters when the bladder becomes full.

• Vesicoureteral reflux causes problems when urine from the bladder, which can carry bacteria, backs up into the kidneys.
• This often results in kidney swelling, urinary tract infection, kidney infection, kidney disease, and kidney failure.

Causes

There are two types of vesicoureteral reflux: primary VUR and secondary VUR. Primary VUR, found most commonly in infants and children, is a congenital defect in which the ureter(s) are usually either too short or too offset to connect properly to the bladder. Secondary VUR is caused by a urinary tract infection or obstruction of the urinary tract.

Symptoms of VUR

Vesicoureteral reflux impacts the function of the urinary system, which includes the kidneys, ureters, bladder, and urethra that work together to remove waste from the body. The kidney functions as a filter for the blood–removing waste, electrolytes, and water. Waste in the form of urine is carried from the kidneys by the ureters that connect them to the bladder. The bladder stores the urine until it is expelled by the urethra during urination.

The most telling symptom that frequently leads to diagnosis of vesicoureteral reflux is a urinary tract infection (UTI) or chronic UTIs. The most common symptoms of UTI include:

• Burning pain with urination
• Frequent urges to urinate
• Urinating in small amounts
• Pain along the sides of the abdomen
• Cloudy urine with a strong odor
• Fever

In infants, vesicoureteral reflux may be discovered during a sonogram if kidney swelling, known as hydronephrosis, is detected. Other symptoms that may indicate a urinary tract infection in infants include:

• Decreased appetite
• Unexplained fever
• Diarrhea
• Irritability
• Vomiting forcefully

Left untreated in infancy, children who suffer from vesicoureteral reflux can experience complications such as:

• Constipation
• Loss of bowel control
• Bedwetting
• Protein in urine
• High blood pressure
• Kidney scarring
• Kidney failure

VUR Treatments

When vesicoureteral reflux is suspected, two common diagnostic tests used for confirmation are a cystourethrogram (VCUG) and a renal ultrasound. The VCUG uses x-ray images to examine the urinary tract while the renal ultrasound uses sound waves to create images of the kidneys and bladder for examination. If vesicoureteral reflux is confirmed, its severity is graded from least severe (grade 1) to most severe (grade 5).

Children with lower grade VUR may outgrow their condition as they age. In such cases, children may be prescribed antibiotics for infection and closely monitored with regular testing. For higher grade VUR, surgery may be required to correct defects or remove obstructions. Surgical procedures may consist of removing and repositioning the ureter or telescopically inserting a bulking agent into the junction of the ureters and bladder to improve the ureters’ ability to close in response to pressure from the bladder muscles.