Vesicoureteral Reflux (VUR) 

What is vesicoureteral reflux?

Urine normally flows from the kidneys, down through the ureters, and into the bladder, where it is stored until urination occurs. The ureters normally have a one-way flap valve to prevent urine from traveling in both directions. During normal urination, the bladder muscle contracts and the sphincter muscle relaxes, allowing the urine to leave the bladder through the urethra. Vesicoureteral reflux (VUR) is a condition in which the urine flows backwards from the bladder to the kidneys, through one or both ureters. 

Why come to The Children’s Hospital for treatment of this condition?

The professionals at The Children’s Hospital in Aurora, Colorado are dedicated to caring for kids. The members of the urology team are experts in pediatric urologic conditions and our surgeons are specialized in both pediatrics and urology. We strive to help patients and families feel educated about their condition, prepared for treatment and fully cared for by our urology team. 

What are the signs and symptoms?

There are no specific signs and symptoms of vesicoureteral reflux, however children who have had a urinary tract infection are more likely to have VUR.

How do you diagnose it?

VUR is usually diagnosed after a child has a urinary tract infection, but can be diagnosed before the child is born on prenatal ultrasound. Diagnosis is usually made around 2 to 3 years of age, but it can be discovered at any time. About 75% of children with VUR are girls. A VCUG x-ray of the kidneys, ureters, bladder, and urethra is necessary to evaluate and diagnose VUR. 

Once diagnosed, the VUR is graded. The grade of VUR indicates how much urine is flowing backward into the ureters and kidneys and helps the provider to determine which type of care is most appropriate. VUR is graded on a scale of 1 to 5.

How is it treated?

VUR often improves when the junction between the bladder and the ureter develops and gradually increases in length as the child grows. The lower the grade of VUR, the more likely it is to disappear. Treatment usually involves the use of a low dose or prophylactic antibiotic to prevent infection, as well as bladder training, and on occasion, additional medication. The goal of treatment is to prevent urinary tract infections and kidney damage from occurring, while normal growth and development allows the VUR to improve or resolve. 

Surgical correction is an option for children with a higher grade of VUR and those who continue to have urinary tract infections. The goal of surgical treatment is to cure the reflux. The following are surgical options for VUR. Your provider will discuss the advantages and disadvantages of each type of surgery. 

Endoscopic surgery

One type of surgical treatment is endoscopic surgery, also known as the Deflux procedure. The surgeon will insert an instrument called a cystoscope into the bladder - once inside the bladder, the surgeon will inject a substance into the area where the ureter meets the bladder. This is done to change the angle of the ureter entering the bladder and correct the VUR. This type of treatment is very easy, but not quite as successful as open reimplantation. The child will require general anesthesia for this procedure, but it is an outpatient surgery.

Open reimplantation 

This type of surgical treatment is performed under general anesthesia through an incision in the lower abdomen. The procedure consists of correcting the flap-valve attachment of the ureter to the bladder in order to stop reflux from occurring. No artificial material is used in this procedure. A catheter will be used to drain the bladder for a few days following surgery and the child will have a short recovery stay in the hospital.

Who gets vesicoureteral reflux and can it be prevented?

Only 1% of healthy children have reflux. In many children, VUR seems to be inherited. If a mother has been treated for VUR, as many as 50% of her children may also have it. VUR cannot be prevented, but most infections that result from VUR can be. 

When should I seek medical attention?

If your child has recently been treated for urinary tract infections, especially infections associated with fever, seek the advice of your provider.