We've all heard of acid reflux — when stomach acids move up into the esophagus
and cause a burning sensation — but there can be other types of reflux in the
body. When urine (pee) refluxes from the bladder to the kidneys, it's called vesicoureteral
Vesicoureteral (ves-ih-koe-yoo-REE-ter-ul) reflux happens when urine abnormally
flows backward from the bladder into the ureters, thin tubes that connect the kidneys
to the bladder. If backed-up urine reaches the kidneys, it can lead to infection,
scarring, and even long-term kidney damage if left untreated. Fortunately, most kids
with VUR don't have a severe case of it and outgrow it with no long-term complications.
Treatment depends on the severity of the condition. In mild cases, no treatment
is necessary. Moderate to severe cases may be treated with antibiotic medicines to
prevent infection. In cases where kids have infections and fevers along with the VUR,
surgery may be needed.
How the Urinary Tract Works
The urinary tract
is made up of two kidneys, two ureters, one bladder, and one urethra. Kidneys are
fist-sized, bean-shaped organs in the back that filter excess fluids and waste products
from the blood and turn them into urine. The urine then flows out of the kidneys through
the ureters, which are long, thin tubes.
The ureters transfer urine to the bladder, a balloon-like organ that stores the
urine until it's emptied during urination. While it's in the bladder, urine is prevented
from flowing back into the ureters by valves in the bladder. During urination, it
exits the body through the urethra, a tube at the bottom of the bladder.
Normally, urine flows from the kidneys to the bladder, but defects in one or both
ureters can allow it to flow the other way. So can a blockage in the ureters or in
When a defect causes the condition, it's called primary VUR. This
is the most common type of VUR affecting kids. If a child is born with primary VUR,
it means that a ureter didn't grow long enough while the baby was in the womb. This
can affect the valve where the ureter enters the bladder. If the valve doesn't shut
properly, urine can flow back up the ureters to reach the kidney. Primary VUR is believed
to be a genetic condition.
If a blockage in the urinary tract obstructs the flow of urine and causes it to
go back into the kidneys, it's called secondary VUR. Kids with this
type of VUR often have reflux in both ureters. Secondary VUR can be caused by nerve
damage, infection, or pressure on the ureter from another organ, such as an enlarged
In some cases, VUR may be detected before a baby is born during a routine prenatal
ultrasound. An ultrasound uses sound waves to create an image of the baby in the womb.
Ultrasounds can sometimes show if a baby has swollen kidneys (hydronephrosis),
which could be a sign of VUR.
If your child has symptoms of a UTI, see a doctor right away. To check for VUR,
the doctor will do a physical examination and ask you questions about your family
medical history. Blood and urine tests may be done to see how well your child's kidneys
are functioning and check for signs of infection or damage to the kidneys.
Doctors can use certain tests to confirm a diagnosis of VUR, such as:
An abdominal ultrasound, also called sonography, uses harmless
sound waves to create images of the urinary tract and may reveal a defect or blockage
that could potentially cause VUR.
A voiding cystourethrogram
(VCUG) is an X-ray image of the bladder and urethra taken while someone is urinating.
In this procedure, a special liquid that can be seen on X-rays is placed in the bladder
through a catheter (rubber tube). X-rays are taken of the bladder while it is full
and while it is being emptied during urination, and then the images are compared to
check for abnormalities.
If VUR is diagnosed, the doctor will grade the condition from I through V based
on its severity, and use the grade to decide the best course of treatment. Grade I
reflux is the mildest, with urine that backs up only as far as the ureters. Grade
V reflux is the most severe and can involve twisting of the ureter and swelling of
In many cases, kids with primary VUR outgrow it. As a child gets older, the ureter
gets longer and straighter, and the valve where the ureter enters the bladder is able
to shut correctly.
VUR that occurs with a UTI needs prompt antibiotic treatment to keep the infection
from spreading to the kidneys. Kids who are put on antibiotics should take them for
as long as prescribed, even if they start to feel better early on.
In moderate to severe cases of primary VUR with UTIs and fever, the doctor may
recommend surgery. The most common type of surgery is ureteral reimplantation,
in which one or both ureters are extended further into the bladder to correct the
backflow of urine from the bladder to the ureters and kidneys. This type of surgery
usually requires kids to spend a few days in the hospital while they recover.
Another surgical procedure, endoscopic injection, involves injecting
a special gel into the bladder with the use of a catheter. The gel, placed near the
valve at the opening of the ureter, prevents urine from going back into the ureter
and helps the valve close properly. Most kids can leave the hospital on the same day
that they have this procedure.
To treat a case of secondary VUR, antibiotics are given to fight infections and
surgery might be done to remove the blockage causing the reflux.
Moderate to severe VUR, if not treated, can lead to serious health problems down
the road. But with prompt treatment, long-term complications and damage to the kidneys
can be prevented./p>