Vesicoureteral Reflux

Urine normally flows from your kidneys, through tubes called ureters, to your bladder. Vesicoureteral reflux (VUR) is when urine flows backward, from the bladder up the ureters to the kidneys. This is not how it's supposed to work.

VUR is most often found in babies and young children. This backward flow can increase the chances of getting a urinary tract infection (UTI). If a UTI isn't treated, it can hurt the kidneys.

Sometimes, children grow out of VUR. Doctors treat VUR to prevent problems with the kidneys. This treatment might involve medicine or surgery.

Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the kidneys. This can lead to urinary tract infections (UTIs).

UTIs are common in people with VUR. While many people with a UTI notice symptoms, some don't. Common UTI symptoms include:

• Frequent urination: Feeling the strong need to pee often.
• Painful urination: A burning sensation while urinating.
• Small amounts of urine: Having to urinate frequently in small amounts.
• Cloudy urine: Urine that looks cloudy or unusual.
• Fever: A rise in body temperature.
• Pain in the lower back (flank) or belly (abdomen): Discomfort in these areas.

Recognizing UTI symptoms in children can be tricky, as they might only show vague signs. Babies with UTIs might also show:

• Unexplained fever: A fever without an obvious cause.
• Poor appetite: Not eating as much as usual.
• Irritability: Feeling fussy or upset.

If VUR isn't treated in children, it can lead to further health problems as they get older, such as:

• Bed-wetting: Inability to control urination at night.
• Bowel problems: Constipation or trouble controlling bowel movements.
• High blood pressure: Increased pressure in the blood vessels.
• Protein in the urine: An indication of kidney problems.

VUR can sometimes be detected before a baby is born. A sonogram (an ultrasound) might reveal swollen kidneys (hydronephrosis) or urinary collecting structures. This swelling is caused by urine backing up into the kidneys.

It's crucial to contact your doctor immediately if you suspect your child has a UTI. Look out for these symptoms:

• Frequent urination: Feeling the strong need to pee often.
• Painful urination: A burning sensation while urinating.
• Pain in the lower back (flank) or belly (abdomen): Discomfort in these areas.

Also, contact your doctor about a fever if your child:

• Is under 3 months old and has a rectal temperature of 100.4°F (38°C) or higher.
• Is 3 months or older and has a fever of 100.4°F (38°C) or higher, and seems unwell.
• Is not eating well or has had significant changes in mood.

Early diagnosis and treatment of UTIs and VUR are important to prevent complications.

If your child shows signs of a urinary tract infection (UTI), see a doctor right away. A UTI can cause several symptoms. These include a strong and constant need to pee, pain or burning when urinating, and stomach or back pain.

Also, call your doctor if your child has a fever. It's especially important to contact a doctor if:

• Babies under 3 months old: have a rectal temperature of 100.4°F (38°C) or higher.
• Children 3 months or older: have a fever of 100.4°F (38°C) or higher and seem unwell. This could mean they're not acting like their usual selves. Look for signs like being listless, irritable, or not eating normally.
• Any child with a fever: if they're also not eating well or have noticeable changes in their mood.

Important Note: These are just guidelines. A doctor can best assess your child's specific situation and recommend the right course of action. If you have any concerns about your child's health, don't hesitate to contact your doctor.

Your urinary system is made up of your kidneys, ureters, bladder, and urethra. These parts work together to get rid of waste from your body in the form of urine.

Sometimes, a condition called vesicoureteral reflux (VUR) can happen. This means urine flows backward, going from the bladder back up the ureters. There are two main types:

1. Primary Vesicoureteral Reflux: This is the more common type. Babies with primary VUR are born with a problem in a special valve that's supposed to keep urine from flowing backward. Imagine a little door that keeps the urine flowing in the right direction. In primary VUR, this door doesn't work properly.

As a child grows, their ureters (the tubes that carry urine from the kidneys to the bladder) usually get longer and straighter. This can sometimes improve the valve's function and fix the reflux. Primary VUR often runs in families, suggesting a possible genetic link, but the exact reason why this valve defect develops isn't completely understood.

2. Secondary Vesicoureteral Reflux: This type of VUR is usually caused by something else affecting the bladder's ability to empty properly. This could be due to a blockage, a problem with the muscles in the bladder, or damage to the nerves that control bladder function. So, unlike primary VUR, the backward flow of urine is a symptom of a different underlying problem.

Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the ureters (the tubes that carry urine from the kidneys to the bladder). Several factors increase a child's chance of having VUR.

Problems with Bladder and Bowel Control: Children with issues controlling their bladder and bowels (bladder and bowel dysfunction, or BBD) are more likely to develop VUR. This is because holding their urine and stool can lead to repeated urinary tract infections (UTIs). UTIs can, in turn, increase the risk of VUR.

Race: Studies suggest that white children might be slightly more prone to VUR than children of other races.

Gender: Girls are more often diagnosed with VUR than boys. However, a different type of VUR, one present from birth, is more common in boys.

Age: Babies and young children (up to about 2 years old) are more susceptible to VUR than older children. This is likely because their urinary systems are still developing.

Family History: If a child's parents or siblings have VUR, they themselves have a higher risk of developing the condition. This is often called "primary" VUR. If a child has VUR, it's important to let their doctor know so that they can consider screening other family members, especially siblings. This proactive screening can help catch the condition early if it's present.

Vesicoureteral reflux (VUR) is mainly a problem because it can harm the kidneys. The stronger the backward flow of urine from the bladder into the ureters (the tubes connecting the bladder to the kidneys), the greater the risk of kidney damage.

This damage can lead to several serious complications. One major concern is kidney failure. The reflux can cause scarring on the kidney tissue. This scarring reduces the kidney's ability to filter waste products from the blood. If the kidney damage is sudden and severe, it can lead to acute kidney failure. If the damage happens gradually, it can cause chronic kidney disease, a long-term condition that progressively worsens over time.

A urine test is often the first step in checking for a urinary tract infection (UTI) in a child. However, other tests might be needed to get a clearer picture.

Imaging Tests:

• Kidney and Bladder Ultrasound: This test uses sound waves to create pictures of the kidneys and bladder. It can show if there are any unusual shapes or structures. Ultrasound is a common and safe procedure, often used during pregnancy to check on the baby's development. It can also show if the kidneys are swollen, a sign of a problem called vesicoureteral reflux.

• Specialized X-ray of the Urinary Tract: This test takes X-rays of the bladder, first when it's full and then as it empties. A thin, flexible tube (catheter) is inserted into the bladder through the urethra. A special dye is put into the bladder through the catheter. The doctor takes X-rays from different angles. Then, the catheter is removed, and more X-rays are taken while the child urinates. This helps determine if the urinary tract is working properly. Possible side effects include some discomfort from the catheter or having a full bladder, and there's a small risk of getting a new urinary tract infection.

• Nuclear Scan: This test uses a special substance (radioisotope) that helps the doctor see how well the urinary tract is working. A scanner detects this substance and creates images of the urinary tract. Potential side effects include discomfort from the catheter or during urination.

Grading the Problem:

After the tests, doctors evaluate the severity of the vesicoureteral reflux. The severity is graded on a scale of I to V.

• Grade I: Urine only backs up a little way, to the ureter.
• Grade V: This is the most serious. The kidneys are very swollen (hydronephrosis), and the ureter might be twisted.

Mayo Clinic Care:

Mayo Clinic has a team of specialists experienced in treating vesicoureteral reflux. They can help you understand and manage your child's condition.

Treating Vesicoureteral Reflux (VUR) in Children

Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder to the ureters (the tubes that carry urine from the kidneys to the bladder). Treatment for VUR depends on how severe it is.

Mild VUR: Some children with mild VUR may simply grow out of it. In these cases, doctors often recommend a "wait-and-see" approach, closely monitoring the child for any problems.

Severe VUR: For more serious cases, several treatment options exist:

Preventing Urinary Tract Infections (UTIs): UTIs are a common concern with VUR because the backward flow of urine can allow bacteria to reach the kidneys. Doctors will often prescribe antibiotics, sometimes at a lower dose, to prevent UTIs.

Monitoring: If a child is taking antibiotics for VUR, they need regular checkups and urine tests. These tests help doctors see if the antibiotics are working and to detect any infections that develop despite the treatment (breakthrough infections). Doctors may also use imaging scans to check on the kidneys and bladder.

Surgery: Surgery is an option for severe VUR. The goal is to fix the valve that controls the flow of urine between the bladder and the ureters. The valve is often faulty, allowing urine to flow backward. Surgery types include:

• Open Surgery: This involves a larger cut in the lower abdomen to repair the valve. It usually requires a hospital stay of a few days and a catheter to drain the bladder. While most children recover well, there's a small chance the VUR might return.

• Robotic-Assisted Laparoscopic Surgery: This surgery uses small cuts and robotic tools to repair the valve. It often leads to less pain and smaller scars, but some studies show it might be slightly less effective than open surgery, and it may take a bit longer.

• Endoscopic Surgery: This is a less invasive approach. A thin, lighted tube is inserted through the urethra to reach the bladder. A special material is then injected around the valve opening to strengthen it. This method has fewer risks than open surgery, but it might not be as effective in correcting the problem. It's often done as an outpatient procedure.

Important Note: The best treatment for VUR depends on the individual child and the severity of their condition. A doctor will carefully consider all the options to determine the best course of action.