Vesicoureteral reflux (VUR) (kidney reflux)

Specialty of Paediatric urology

What is vesicoureteral reflux?

Vesicoureteral reflux (VUR), also known as vesico-ureteric reflux, is a condition affecting the urinary system that usually occurs in children. Normally, urine flows from the kidneys to the bladder in one direction via tubes called ureters. However, in VUR, urine is able to reflux back up one or both ureters, sometimes even all the way to the kidneys.

Prognosis of vesicoureteral reflux

Vesicoureteral reflux is often associated with other urinary conditions. The kidneys can become swollen with a condition called hydronephrosis when urine repeatedly refluxes back to them.

The reflux of urine can also increase the risk of urinary tract infections (UTIs), which are more likely to spread further up the urinary tract. If these infections reach the kidneys, they can lead to kidney damage. Long-term effects can include high blood pressure and even kidney failure.

Symptoms of vesicoureteral reflux

VUR is usually diagnosed after the patient has suffered a series of urine infections. Symptoms of urine infections include:

  • Frequent urination
  • Pain or burning while urinating
  • Urinary urgency
  • Blood in the urine
  • Abdominal pain
  • Fever

The presence of hydronephrosis is also an indicator – the kidney becomes swollen with urine as it becomes backed up from the ureter and this is usually visible on scans.

In young children, the problem may be harder to spot. Signs to watch out for include unexplained fevers, any changes in urinary or bowel habits, loss of appetite, and irritability.

Medical tests to diagnose vesicoureteral reflux

VUR may be diagnosed by:

  • Ultrasound scans
  • Micturating cysto-urethrogram (MCUG) – this uses a liquid that shows up on the scan. The liquid is inserted into the bladder and the child is scanned while urinating so that the doctor can observe the behaviour of the liquid and whether any of it is refluxing back towards the kidneys when the bladder contracts.

What are the causes of vesicoureteral reflux?

Vesicoureteral reflux can be one of two types:

  • Primary vesicoureteral reflux – the child was born with a defect in the valve at the bottom of the ureter, where it connects to the bladder. This valve is supposed to close to prevent the backflow of urine; however, abnormalities in the bladder wall can mean the valve cannot close properly, allowing urine to reflux back into the ureter.
  • Secondary vesicoureteral reflux – the condition can occur due to a urinary tract malfunction, often caused by high bladder pressure.

Can vesicoureteral reflux be prevented?

The condition itself can’t be prevented, but the chances of UTIs can be reduced by drinking plenty of fluid and going to the toilet regularly.

Treatments for vesicoureteral reflux

Many children outgrow VUR – the bladder wall and ureter develop further and where the ureter’s path through the bladder wall was once too short, it can grow to fit better and allow the valve to close, preventing the reflux of urine. In such cases, a low dose of antibiotics to combat and prevent UTIs may be given for the first few years of the baby’s life until the VUR resolves itself.

In other cases, the child may continue to have severe VUR after the age of five, in which case an operation may be needed:

  • Endoscopic injection – a tube complete with a small camera and a light is passed into the bladder. The valve is repaired with an injection into the ureter. The procedure is performed under general anaesthetic. It is usually done as an outpatient procedure, so the patient should be able to return home the same day.
  • Deflux® injection
  • Ureteric reimplantation – a more invasive procedure. The surgeon disconnects the ureters from the bladder and moves them, creating a new path through the bladder wall at the correct angle to create a valve. The patient will need to stay in hospital for a short time while they recover.

Which type of specialist treats vesicoureteral reflux?

Vesicoureteral reflux is typically treated by paediatric urologists due to the fact that it is usually diagnosed and treated in children. In adults, it may be treated by urologists.

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