Vesicoureteral Reflux (VUR)
What is vesicoureteral reflux?
Vesicoureteral reflux (VUR) is a condition where urine in the bladder flows backward
into tubes called ureters and often back into the kidneys.
Normally urine flows in one direction. It flows down from the kidneys through the
ureters to the bladder. The bladder is the organ that stores urine before urination
happens. The bladder has 3 small openings. Two openings at the top connect the bladder
to the ureters. One opening at the bottom connects the bladder to the urethra, where
urine exits the body.
The ureters have a special 1-way valve system that normally stops urine from flowing
back up to the kidneys. When a child has vesicoureteral reflux, this valve system
doesn’t work. Urine can then flow backward (reflux) into the ureters and may enter
This condition is most often diagnosed in infancy and childhood. A child who has VUR
is at risk for developing recurrent kidney infections. Over time this can cause damage
and scarring to the kidneys.
What causes vesicoureteral reflux?
There are many different reasons why a child may develop VUR. Some of the more common
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, VUR is more common
in girls. It is more common in white children than in African-American children.
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. Symptoms of a UTI may include burning or pain with urination,
frequent urination, fever, and back pain. These symptoms 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 healthcare provider for a diagnosis.
How is vesicoureteral reflux diagnosed?
VUR can often be found by ultrasound before a child is born. Sometimes there may be
a family history of VUR, but the child has no symptoms. In those cases the healthcare
provider may choose to do a diagnostic test to rule out VUR. Diagnostic tests for
VUR may include:
Voiding cystourethrogram (VCUG). A VCUG is a specific X-ray that examines the urinary tract. A hollow tube (catheter)
is placed in the urethra. This tube 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. A probe (transducer) is passed over the kidney on the
outside of the body. It makes sound waves that bounce off the kidney and transmit
a picture of the organ onto a video screen. The test is used to figure out the size
and shape of the kidney. It can also find a mass, kidney stone, cyst, or other blockages
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 infections and permanent kidney damage.
Your child's healthcare provider will figure out the best treatment plan for your
child based on:
Your child’s age, overall health, and medical history
How sick your child is
How well your child handles certain medicines, treatments, or therapies
If your child’s condition is expected to get worse
The opinion of the healthcare providers involved in your child's care
Your opinion and preference
Your child's healthcare 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 grade 3 VUR don’t need any type of intense
therapy. The reflux goes away 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 grade 5 reflux may need surgery. During the procedure,
the surgeon will create a flap-valve device 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 VUR. Talk with your child's healthcare provider
for more information.