Vesicoureteral Reflux (VUR)
What is vesicoureteral reflux?
Vesicoureteral reflux happens when urine dwelling in the bladder flows back into the
ureters and often back into the kidneys. The bladder is the hollow, muscular organ
that stores urine before urination happens. The bladder has 3 small openings; 2 connect
the ureters where urine is drained down from the kidneys, and 1 connects the bladder
to the urethra where urine exits the body.
The ureters are funnel-shaped tubes that carry urine from the kidneys. Ureters enter
the bladder at a diagonal angle and have a special 1-way valve system that normally
prevents urine from flowing back up the ureters in the direction of the kidneys. When
a child has vesicoureteral reflux, the mechanism that prevents the backflow of urine
does not work, allowing urine to flow in both directions. This condition is most frequently
diagnosed in infancy and childhood. A child who has vesicoureteral reflux is at risk
for developing recurrent kidney infections. This, over time, can cause damage and
scarring to the kidneys.
What causes vesicoureteral reflux?
There are many different reasons why a child may develop vesicoureteral reflux. Some
of the more common causes include:
Having parents or siblings with VUR
Being born with neural tube defects like spina bifida
Having other urinary tract abnormalities, like posterior urethral valves, ureterocele,
or ureter duplication
During infancy, the disease is more common among boys because as they urinate there
is more pressure in their entire urinary tract. In early childhood, the irregularity
is more common in girls. VUR is more common in white children than in African-American
What are the symptoms of vesicoureteral reflux?
The following are the most common symptoms of vesicoureteral reflux. However, each
child may experience symptoms differently. Symptoms may include:
Urinary tract infection. Urinary tract infections are uncommon in children younger
than age 5. They are unlikely in boys at any age, unless VUR is present.
Trouble with urination including:
A stomach mass from a swollen kidney
Poor weight gain
High blood pressure
The symptoms of VUR may look like other conditions or medical problems. Always talk
with your child's health care provider for a diagnosis.
How is vesicoureteral reflux diagnosed?
VUR can often be found by ultrasound before a child is born. If there is a family
history of VUR, but your child has no symptoms, your child's health care provider may
choose to do a diagnostic test to rule out VUR. Diagnostic procedures for VUR may
Voiding cystourethrogram (VCUG). A VCUG is a specific X-ray that examines the urinary tract. A catheter (hollow tube)
is placed in the urethra. This is a tube that drains urine from the bladder to the
outside of the body. The bladder is filled with a liquid dye. X-ray images will be
taken as the bladder fills and empties. The images will show if there is any reverse
flow of urine into the ureters and kidneys.
Renal ultrasound. This is a noninvasive test in which a transducer is passed over the kidney. It produces
sound waves that bounce off the kidney and transmit a picture of the organ on a video
screen. The test is used to determine the size and shape of the kidney, and to find
a mass, kidney stone, cyst, or other obstruction or abnormalities.
What is the treatment for vesicoureteral reflux?
VUR can happen in varying degrees of severity. It can cause mild reflux, when urine
backs up only a short distance in the ureters. Or, it can cause severe reflux leading
to kidney infection(s) and permanent kidney damage. Specific treatment for VUR will
be decided by your child's health care provider based on:
Your child's age, overall health, and medical history
The extent of the condition
Your child's tolerance for specific medicines, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Your child's health care provider may assign a grading system (ranging from 1 to 5)
to indicate the degree of reflux your child has. The higher the grade, the more severe
Most children who have grade 1 through 3 VUR do not need any type of intense therapy.
The reflux resolves on its own over time, usually within 5 years. Children who develop
frequent fevers or infections may need ongoing preventive antibiotic therapy and periodic
urine tests. Surgical treatment is also available.
Children who have grade 4 and 5 reflux may require surgery. During the procedure,
the surgeon will create a flap-valve apparatus for the ureter that will prevent reverse
flow of urine into the kidney. In more severe cases, the scarred kidney and ureter
may need to be surgically removed.
New treatments are being introduced for vesicoureteral reflux. Talk with your child's
health care provider for more information.