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Vesicoureteral Reflux (VUR)

Conditions

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The urinary tract includes 2 kidneys, 2 ureter tubes, a bladder and a urethra. This is the body's drainage system for removing waste and extra water. Urine should flow in one direction down from the kidneys, through the ureter tubes, to the bladder and out the urethra. Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder to one (or both) ureters. In some cases, the urine flows all the way back to the kidneys. This can lead to kidney infection, scarring, and damage.

VUR may be diagnosed at any age, even in newborn babies or older children. The average age at diagnosis is two to three years. About one-third of children with urinary tract infections (UTIs) are diagnosed with VUR. VUR is believed to be present in 1% or less of [healthy] children.[1]

[1] From "Vesicoureteral Reflux," by Larry A. Greenbaum, MD, PhD, and Hrair-George O. Mesrobian, MD, MSc, Pediatrics Clinics of North America, 53, p. 1. Copyright 2006.

Patients can be seen by Texas Children's experts in Urology.

Causes & Risk Factors

Primary VUR

In most children, VUR is a birth defect caused by an unusual attachment between the ureter tube and the bladder. This is known as primary VUR and it is the most common type. Primary VUR often affects only one ureter and one kidney but can affect both kidneys. In some cases, the VUR heals or disappears as a child gets older. The exact cause of VUR is unknown.

Secondary VUR

Secondary VUR occurs when there is a blockage in the bladder or urethra. This blockage causes urine to flow backward into the kidneys. This can happen at any age. Causes of Secondary VUR can include:

  • Surgery
  • Injury
  • Recurrent UTIs
  • An abnormal pattern of emptying the bladder
  • A past infection that has put pressure on the bladder

Secondary VUR is more common in children who have other birth defects, such as spina bifida. Secondary VUR often affects both ureters and both kidneys.

Risk factors include:

  • Race - Caucasian children tend to have a higher risk of VUR than other children.
  • Gender - Girls have about twice the risk of having Secondary VUR as boys. Primary VUR is more common in girls.
  • Age - Infants and young children are more likely to have VUR than older children and adults.
  • Genetics - Primary VUR tends to run in families. Children whose parents had the condition are at higher risk of developing it. [1]

[1] From Medical News Today. "What is Vesicoureteral Reflux (VUR)?" http://www.medicalnewstoday.com/articles/189144.php

Symptoms & Types

In many cases, a child with VUR has no symptoms. UTIs are the most common symptom.

But a UTI doesn't always have noticeable symptoms. If they do have noticeable symptoms, these can include:

  • Strong, persistent urge to urinate
  • Burning sensation while urinating
  • Passing frequent, small amounts of urine
  • Blood in the urine or cloudy, strong-smelling urine
  • Fever
  • Pain in the side or stomach
  • Hesitancy to urinate
  • Holding urine to avoid the burning sensation

Symptoms in infants with a UTI may include:

  • Unexplained fever
  • Diarrhea
  • Lack of appetite
  • Irritability

Untreated VUR can lead to other symptoms, including:

  • Bed-wetting
  • Constipation or loss of control over bowel movements
  • High blood pressure
  • Protein in urine
  • Kidney failure

Diagnosis & Tests

An ultrasound can suggest the possibility of VUR before birth. A fetus may have VUR if the sonogram shows swelling of the kidneys.

VUR is often diagnosed in children when a UTI is suspected. After a UTI is confirmed, tests will be done to see if your child has VUR. The most common tests to diagnose VUR include:

  • Kidney and bladder ultrasound
  • Voiding cystourethrogram (VCUG)
  • Radionuclide cystogram (RNC)
  • Renal Scan

VUR testing is usually done on:

  • Infants who were diagnosed with urine blockage or swollen kidneys during pregnancy
  • Children with a UTI and a fever, regardless of age
  • Males with a UTI, regardless of age or fever
  • Children with a family history of VUR, including siblings

Children with VUR should also be assessed for bladder/bowel dysfunction (BBD) such as constipation or holding of the urine. Children who have VUR along with any BBD symptoms are at greater risk of kidney damage.

VUR often disappears around age five or six. Medical treatment is often used to prevent UTIs and kidney damage during the child's development.

Treatment & Care

Many children with VUR urinate infrequently and/or incompletely. These children are at particular risk for kidney infection.

Treatment options for VUR depend on the severity of the condition. Treatments may include:

  • Medications
  • Treatment and prevention of UTIs
  • Physical exams and urine tests
  • Urinary catheter (drainage tube) inserted into the bladder
  • Surgery (open surgery or robotic surgery)
  • Specialized injection to create a new valve that prevents the back flow of urine into the kidneys

Living & Managing

While managing your child's urinary tract infection (UTI) that is associated with VUR, the following steps will help ease discomfort:

  • Encourage your child to drink fluids, particularly water, to flush out bacteria
  • Avoid juices and soft drinks containing citrus and caffeine until the UTI has cleared
  • Provide a warm blanket or towel to help minimize feelings of bladder pressure or pain

After treatment, you'll want to keep a close watch to make sure your child does not continue to have problems. Regular follow-ups will be needed with your physician. The importance of routine follow-up care cannot be overemphasized. Not following through may result in continued problems with VUR or renal failure in certain children.

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Date Reviewed

Thursday, August 21, 2014