Urine normally flows out from the kidneys. It passes through tubes called ureters. It then flows into the bladder. Each ureter connects to the bladder in a way that prevents urine from flowing back up the ureter. This connection is similar to a one-way valve. When this does not work properly, or if the ureters do not extend far enough into the bladder, urine may flow back up to the kidney. If the urine contains bacteria, the kidney may become infected. The back-up can also put extra pressure on the kidney. This can cause kidney damage.

This is a potentially serious condition. It requires care from a doctor. Early treatment and prevention of infections can lead to better outcomes.

The Urinary Tract

Causes

Common causes of VUR include:

A problem in the way the ureter inserts into the bladder
A ureter that does not extend far enough into the bladder
Neurogenic bladder —loss of normal bladder function due to damaged nerves reaching the bladder

Risk Factors

Things that may increase your child’s chance of developing VUR include:

Family history (especially if a sibling or parent has VUR)
Birth defects that affect the urinary tract
Birth defects that affect the spinal cord, such as spina bifida
Tumors in the spinal cord or pelvis

Symptoms

Your child may not have any symptoms. In some cases, VUR is found after a urinary tract or kidney infection is diagnosed. Symptoms of urinary tract infections include:

Frequent and urgent need to urinate
Passing small amounts of urine
Pain in the abdomen or pelvic area
Burning sensation during urination
Cloudy, bad-smelling urine
Increased need to get up at night to urinate
Blood in the urine
Leaking urine
Low back pain or pain along the side of the ribs
Fever and chills

Diagnosis

You will be asked about your child’s symptoms and medical history. A physical exam will be done. Tests may include:

Blood tests—to assess how well the kidneys are functioning
Urine tests—to look for evidence of an infection or damage to the kidneys
Voiding cystourethrogram (VCUG)—a liquid that can be seen on x-rays is placed in the bladder through a catheter; x-rays are taken when the bladder is filled and when urinating
- Note: This test is not done routinely in children aged 2-24 months.
Radionuclide cystogram (RNC)—a test like VCUG, but uses a different kind of liquid to obtain images
IV pyelogram —also uses a liquid that can be seen on x-rays; images are taken as the substance travels from the blood (after being injected into a vein) into the kidneys and bladder
Nuclear scans—a variety of tests using radioactive materials injected into a vein to show how well the urinary system is working

Your child's condition will be graded. The grading scale ranges from 1 (mild) to 5 (severe).

Treatment

The goal for treatment of VUR is to prevent any permanent kidney damage. Treatment options include:

Monitoring

Treatment may not be needed for grades 1-3. Higher grades may require treatment.

VUR may go away on its own as the ureters develop. Your child's condition will be monitored. This may include:

Antibiotics
- Preventive antibiotics may be given under certain conditions, depending on your childs age, history of urine infections, and grade of reflux.
- Antibiotics will be used if a urine infection is present.
Tests to check how the kidneys are functioning

Children are advised to stay well-hydrated by drinking plenty of fluids. They should also empty their bladders frequently.

Surgery

In most cases, surgery is not needed. If your child does need surgery, the options include:

Ureteral reimplantation surgery—This can be done in two ways. One requires making an incision above the pubic bone and repositioning the ureters in the bladder. It can also be done laparoscopically, with cameras being inserted through small incisions in the abdomen and/or bladder to do the surgery.
Endoscopic injection into the ureter—This is a minimally invasive surgery that is done to correct the reflux. A gel is injected where the ureter inserts into the bladder. This can block urine from flowing back up the ureter.

Prevention

VUR cannot be prevented in most cases. Avoid complications by getting prompt treatment. If you suspect a urinary tract or kidney infection, call your child's doctor.

RESOURCES:

National Kidney Foundation
http://www.kidney.org

Urology Care Foundation
http://www.urologyhealth.org/

CANADIAN RESOURCES:

HealthLinkBC
https://www.healthlinkbc.ca

The Kidney Foundation of Canada
http://www.kidney.ca

References:

Valla JS, Steyaert H, et al. Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: A single-centre 5-year experience. J Pediatr Urol. 2009;5(6):466-471.

Vesicoureteral reflux (VUR). Cincinnati Children’s website. Available at:
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Accessed January 28, 2021.

Vesicoureteral reflux (VUR) in children. Boston Children’s Hospital website. Available at:
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Accessed January 28, 2021.

Vesicoureteral reflux. EBSCO DynaMed website. Available at:
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Accessed January 28, 2021.

Last reviewed March 2020 by EBSCO Medical Review Board Chelsea Skucek, MSN, BS, RNC-NIC
Last Updated: 1/28/2021

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