Vesicoureteral Reflux: A Clear Explanation

Vesicoureteral Reflux: A Clear Explanation | UPMC Italy

If your child frequently experiences urinary tract infections (UTIs), it may be a sign of an underlying issue. One common reason is Vesicoureteral Reflux (VUR). This condition involves the abnormal movement of urine within the urinary system, where urine flows back from the bladder to the kidneys instead of moving in the correct direction outward.

Here's what you need to know about this relatively common childhood condition.

What is Vesicoureteral Reflux?

VUR occurs when some urine flows in the wrong direction. In children with VUR, bacteria can travel up to the kidneys, causing kidney infections and potential permanent organ damage.

Risk Factors and Classification of VUR

VUR is more common in girls than in boys, and the likelihood increases if a parent or sibling has had this condition.

There are two types of VUR:

  • Primary VUR: This occurs when a child is born with one or both ureters (the tubes connecting the kidneys to the bladder) being abnormal. The valve between the ureter and the bladder doesn't close properly, allowing urine to flow back to the kidney. The exact cause of primary VUR is not fully understood, but genetics may play a role.
  • Secondary VUR: This happens when an obstruction develops somewhere in the child's urinary tract. The obstruction could be due to a fold of tissue in the bladder neck or urethra, blocking the urine's proper outflow and causing it to rise back to the kidneys.

Doctors classify VUR based on its severity, assigning it a grade from one (mild) to five (severe), considering the amount of urine that flows back and the size of the ureter. Cases with lower grades (one or two) are likely to resolve on their own within a few years.

Symptoms of Vesicoureteral Reflux

VUR usually doesn't present noticeable symptoms until it leads to a urinary tract infection. Symptoms of a UTI include:

  • Frequent and urgent need to urinate.
  • Bedwetting and daytime accidents.
  • Burning sensation during urination.
  • Presence of blood in the urine.
  • Unpleasant-smelling and cloudy urine.
  • Vomiting.
  • Pain in the side or abdomen (in the case of kidney infection).
  • Fever and chills (in the case of kidney infection).

Often, along with VUR, other bladder or intestinal problems may occur. Besides UTIs, a child with VUR is more likely to experience urinary incontinence, bedwetting issues, urinary retention, and constipation, as urinary and intestinal problems can be closely related.

Complications of Vesicoureteral Reflux

On the other hand, kidney infections can be more severe and cause kidney damage. Kidney infections can lead to high blood pressure and reduced kidney function. In some cases, VUR can cause an enlargement of the kidneys, known as hydronephrosis.

Diagnosis of Vesicoureteral Reflux

VUR can be discovered before birth during a routine prenatal ultrasound that may reveal hydronephrosis or swelling along the urinary tract, but more often it is detected when children are two or three years old and start experiencing frequent urinary tract infections.

If the child shows symptoms of a UTI, it is crucial to seek immediate medical attention.

To diagnose VUR, the doctor may use the following tests:

  • Blood and urine tests to assess kidney function and detect signs of infection or kidney damage.
  • Abdominal ultrasound to visualize any defects or obstructions in the urinary tract.
  • Voiding cystourethrogram (VCUG), a test that uses a special liquid to fill the child's bladder while a technician takes X-rays during urination. These images help doctors identify any issues.

Treatment of Vesicoureteral Reflux

The treatment of VUR varies depending on its severity. Treatment options include:

  • Observation: In mild cases, the doctor may decide not to intervene immediately as many children naturally outgrow VUR within five years.
  • Antibiotics: For more severe cases, the doctor may prescribe a low dose of antibiotics to reduce the risk of urinary tract infections and allow the condition to resolve naturally.
  • Surgery: If VUR continues to cause kidney infections, surgical intervention may be necessary to correct the reflux and prevent further damage.

Preventing Urinary Tract Infections

To prevent urinary tract infections caused by VUR, it is essential to follow these guidelines:

  • Ensure the child drinks plenty of fluids.
  • Teach the child to urinate regularly to keep the bladder free from bacteria.
  • Teach the child to wipe correctly after urination, avoiding the spread of bacteria from feces to the urinary tract.
  • Change wet or soiled diapers frequently to avoid urine stagnation.
  • Help the child maintain regular bowel function to reduce the risk of urinary tract infections.

In conclusion, if your child shows symptoms of a urinary tract infection, it is crucial to consult a doctor. With proper observation and treatment, most cases of VUR can be successfully managed without causing lasting damage.

If you have any questions or doubts, please take advantage of our Open Day dedicated to Pediatric Urology, with Prof. Giacinto Marrocco, Medical Specialist in Pediatric Clinic and Pediatric Surgery, and Dr. Maria Luisa Perrotta, Medical Specialist in Pediatric Urology Surgery.