Vesicoureteral reflux (VUR) occurs when urine in the bladder flows back into the ureters and kidneys. This condition is most frequently diagnosed in infancy and childhood. A child who has vesicoureteral reflux is at risk for developing recurrent kidney infections, which, over time, can cause damage and scarring to the kidneys.
There are many different reasons why a child may develop vesicoureteral reflux. Some of the more common causes include:
During infancy, the disease is more common among boys because as they urinate, there is more pressure in their entire urinary tract. In early childhood, irregularity is more common in girls. VUR is more common in Caucasian children than in African-American children.
The following are the most common symptoms of vesicoureteral reflux, however, each child may experience symptoms differently. Symptoms may include:
The symptoms of VUR may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
VUR can often be suspected by ultrasound before a child is born if there is stretching of the kidney (hydronephrosis), but this does not prove that reflux is present. If there is a family history of VUR, but your child has no symptoms, your child's physician may elect to perform a diagnostic test to rule out VUR.
Diagnostic procedures for VUR include:
VUR can occur in varying degrees of severity. It can be very mild when urine backs up only a short distance in the ureters. Or, it can be severe and lead to kidney infections and permanent kidney damage (scarring). A Children’s National, specific treatment for VUR will be determined by your child's doctor based on:
Your child's doctor may assign a grading system (ranging from 1-5) to indicate the degree of reflux. The higher the grade, the more severe the reflux.
Most children who have grade 1 through 3 VUR do not need any type of intense therapy. The reflux resolves on its own over time, usually within five years. Children who develop frequent fevers or infections may require ongoing preventive antibiotic therapy and periodic urine tests.
Preventive antibiotics have been shown to stop urinary infection s in some cases and pose little risk of problems. They do not make your child less immune to disease or infection. The doses used are very low, just enough to prevent a urinary infection from starting. While you are waiting for the reflux to go away, it is sometimes best to keep your child on a preventive antibiotic so that they do not have more infections.
Surgical treatment is also available.
Children who have grade 4 and 5 reflux may require surgery. During the procedure, the surgeon will create a flap-valve apparatus for the ureter that will the urine from flowing into the kidney. In more severe cases, the scarred kidney and ureter may need to be surgically removed.
The procedure can be performed through open surgery, laparoscopic surgery, and robotic surgery.