Vesicoureteral Reflux

What Is Vesicoureteral Reflux?

Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder up the ureters toward the kidneys. It is most common in infants and young children affecting 1-2% of newborns and 30-45% of children with urinary tract infections (UTIs). Siblings of a child with VUR are more likely to have VUR.

Sterile reflux is not considered a significant problem. However, VUR is often associated with kidney infections, which can lead to kidney scarring. Kidney scarring is associated with high blood pressure and can affect kidney growth and function.

Vesicoureteral reflux may be diagnosed in infancy if the infant has a urinary tract abnormality detected before birth. However, most often VUR is diagnosed after a UTI. It is often found at 2-3 years of age, when children are toilet training.

Symptoms

When a UTI is present, the usual symptoms are painful urination, fever, back pain, wetting accidents, and other urinary symptoms. Most children with VUR who get a UTI recover without long term complications. Most vesicoureteral reflux resolves spontaneously as children grow. However, if a child outgrows VUR, long term monitoring of kidney function and blood pressure is still necessary.

What Causes VUR and Kidney Infections

Vesicoureteral reflux is due to an abnormal connection between the ureter and bladder, allowing backflow of urine up the ureter. Bacteria may also travel up to the kidneys and cause a kidney infection. Most often, the infecting bacteria come from the colon. If a child has difficulty stooling, this affects bladder function as well as providing bacteria for infection.

Diagnosis

Urinalysis and culture, ultrasound of the kidneys, ureters and bladder, voiding cystogram (VCUG), renal scan, renal function testing, and voiding pattern studies.

Treatment

• Treatment depends on the age of the child and severity of the UVR.
• Children with UTI and fever should be evaluated for VUR after the infection has been treated.
• After the diagnosis of VUR, prophylactic antibiotics are often prescribed to prevent future infections and reduce the risk of kidney scarring.
• Mild to moderate VUR often resolves spontaneously as children grow.
• More severe VUR or VUR that persists may require surgery. Surgical correction of VUR substantially reduces the likelihood of more kidney infections.
• Annual follow-up is recommended through adolescence.

Children’s Hospital at Erlanger Urology has the only fellowship trained pediatric urologists in the region who provide care to the children of Chattanooga, Tennessee, Knoxville, TN, Alabama and northern Georgia. They are fellowship trained, board certified pediatric surgeons who regularly treat urinary reflux through state-of-the-art medicine and surgery. Please allow us to assist in all of you pediatric urology needs and thank you for making us one of the leading urology groups in the Southeast.