What is Vesicoureteral Reflux (VUR)?

Vesicoureteral reflux, also known as VUR, is when the normal flow of urine reverses direction. Therefore, urine travels from the bladder back into the ureter and the kidneys, which can cause infections and injury to the kidneys. This condition is most common in infants and young children, although it can also affect older children and adults. VUR goes by several names, such as kidney reflux, urinary reflux and VUR reflux.

Symptoms

If you develop vesicoureteral reflux, you are likely to experience symptoms related to your bladder, kidney and urination.

Vesicoureteral reflux symptoms can include:

• An insistent urge to urinate.
• A burning feeling when you urinate.
• A constant need to void small amounts of urine.
• Urine that looks cloudy.
• Fever or feeling ill.
• Discomfort and pain in your side or stomach.

It may be difficult to assess symptoms in infants. Additional kidney reflux symptoms can include:

• Reduced appetite
• Irritability

Signs and symptoms often present in older children:

• Wetting the bed, or lack of nighttime control of urination.
• Constipation, or the inability to void stool.
• Reduced control of bowel movements.
• High blood pressure.
• Protein present in urine.

Causes

There are two types of VUR, primary and secondary. Each type has a different cause. The vesicoureteral reflux causes relate to how urine flows through your body.

The two types of vesicoureteral reflux:

• Primary vesicoureteral reflux: Children with this type of VUR are born with a defect in the valve that usually stops urine from flowing back into the ureters. This is the more common type of VUR. There is no known cause for primary vesicoureteral reflux.
• Secondary vesicoureteral reflux: This type of VUR is caused by a blockage or failure of the bladder muscle. It can also be caused by injury to the nerves that control the typical process by which the bladder empties of urine.

Risk Factors

There are several recognized risk factors for vesicoureteral reflux. These risk factors include genetics, gender, age, and other health conditions. White females under the age of two with a family history of kidney reflux are at the highest risk of developing VUR. However, baby boys are more likely to be born with urinary reflux.

Vesicoureteral reflux risk factors:

• Race
• Sex
• Age
• Family history
• Sexually transmitted infections
• Bladder and bowel dysfunction (BBD)

Diagnosis

Your doctor will diagnose vesicoureteral reflux following a routine physical exam. As part of your exam, your doctor will inquire about your medical history, family history and symptoms. In older children and adults, your doctor may also ask about sexual activity. Your doctor will then recommend other tests to confirm a urinary reflux diagnosis.

Common types of kidney reflux tests:

• Abdominal ultrasound: An ultrasound uses sound waves to look inside your kidneys and bladder.
• Voiding cystourethrogram (VCUG): This test uses X-rays to determine the directional flow of your urine.
• Lab Test/Urine Culture: You doctor will test a sample of your urine for white blood cells and bacteria, signs of a urinary tract infection.

Treatment

Vesicoureteral reflux treatment options vary based on symptom and condition severity. Children with milder cases of primary vesicoureteral reflux sometimes naturally grow out of VUR. Your doctor may recommend waiting to see if your child grows out of the condition.

For severe cases of vesicoureteral reflux, your treatment options might include:

• Medication: Antibiotics can help manage, reduce, and prevent urinary tract infections.
• Open surgery: A surgeon will make a small incision in your lower abdomen to fix the cause of your VUR.
• Robotic-assisted laparoscopic surgery: Your surgeon will use a medical robot to make tiny incisions and to repair the valve that connects the ureter and the bladder.
• Endoscopic surgery: Your surgeon will use a tube fitted with a small light to see inside your bladder. Your doctor will then add a thickening agent to the entrance of the impacted ureter to enhance the ability of the valve to close effectively.

If surgery is necessary, it can be helpful to consider kidney reflux surgery side effects. Possible side effects might be damage to your kidney or urethra and recovery time. We recommend that you discuss potential side effects with your physician.

If you or a loved one experience any of the symptoms of vesicoureteral reflux, please reach out to our compassionate team of medical professionals at Baptist Health.