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Vesicoureteral Reflux

Vesicoureteral reflux is a condition in which urine, instead of flowing normally from the bladder to the outside, moves backward into the ureters and sometimes up to the kidneys. This backward flow can increase the risk of recurrent urinary infections in children, especially in the early years of life.

Vesicoureteral reflux is a relatively common condition in pediatric patients, affecting about 1% of children. Early recognition is crucial to prevent complications involving the upper urinary tract.

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What Is Vesicoureteral Reflux?

Vesicoureteral Reflux (VUR) is a disorder in which urine flows in the wrong direction, moving backward from the bladder into the ureters and, in more severe cases, up to the kidneys. This reflux can promote the ascent of bacteria, increasing the risk of kidney infections and potential permanent damage to renal tissue, especially in young children.

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 – Present from birth, it is caused by a congenital malformation of the ureters or the valve between the ureter and the bladder, which doesn’t function properly. There may be a genetic component involved.
  • Secondary VUR – This develops due to an obstruction in the urinary tract, such as an anomaly in the bladder neck or urethra, which prevents normal urine flow.

VUR is classified into five severity grades (I to V), based on how much urine refluxes and how dilated the ureters and kidneys are. Mild cases (grades I and II) tend to resolve spontaneously as the child grows.

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What Are the Signs and 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.

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

Kidney infections caused by VUR can be serious and lead to permanent kidney damage. If left untreated, reflux can result in complications such as:

  • Hypertension (high blood pressure).
  • Reduced kidney function.
  • Hydronephrosis, an enlargement of the kidneys due to urine buildup.

It is essential to intervene promptly to prevent irreversible damage and ensure long-term kidney health.

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How Do You Diagnose 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.

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How Do You Treat 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.

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Reviewed March 2025.