Vesicoureteral reflux (VUR) occurs because of a back flow between the bladder and the kidneys.
Vesicoureteral reflux is a condition that occurs in the urinary tract of children. It can occur prenatally or in a young patient. The condition can be quite serious if left untreated, but there are effective treatments that are commonly used and successful.
During normal operation, urine flows from the kidneys through a tube called a ureter to the bladder. Generally, there is one ureter for each kidney but occasionally there are two tubes that may drain the kidney. There is a type of valve in the bladder wall where each ureter enters the bladder that prevents urine from flowing back into the ureters and up to the kidneys. If this valve is not functioning properly, urine can flow back into the kidney. In the presence of a bladder infection, where most urinary infections start, this can set up an infection of the kidney. If this is severe enough, it can result in kidney damage and possibly kidney failure.
Causes of VUR
There are two main causes of VUR.
- Some children have a congenital abnormality of the valve. This is known as primary VUR.
- A child that is born with normal valves between the bladder and ureters may develop secondary VUR. This condition is due to a urinary tract infection, neurogenic bladder, significant voiding dysfunction, or a blockage somewhere along the urinary tract.
Symptoms of VUR
In the youngest children, VUR is usually diagnosed when a urinary tract infection brings them to the doctor. In older children, there are a wider variety of symptoms. The kidney may develop an infection. They may also have fevers or blood in their urine.
If VUR is suspected, there are a few different tests the doctor may perform. A VCUG, an X-ray of the bladder and urethra using a bladder catheter and x-ray contrast material, will be needed to see if your child has VUR.
Treatment Options for VUR
Children with primary VUR will often outgrow the condition. They must be routinely monitored, usually with an ultrasound, to ensure that things are proceeding as expected.
In either primary or secondary VUR, if antibiotics cannot control an infection, surgery may be necessary. There are several ways to surgically correct the VUR.
- One is an open surgery that involves cutting the ureter and moving it into a different area of the bladder to make a tunnel to prevent the VUR. This can also be done using a robot or laparoscopic approach in some cases. The object is to correct any structural abnormalities.
- An alternative surgical approach is to use a cystoscope and inject a bulking agent to improve the function of the valve between the ureter and bladder.