What is Vesicoureteral Reflux

Vesicoureteral reflux is a condition in which urine from the bladder goes back into the tubes that connect the kidneys to the bladder (ureters). The bladder stores urine after the urine is made by the kidneys. In severe cases of vesicoureteral reflux, urine may flow back through the ureters and into the kidneys. This condition can affect one or both kidneys and ureters.

Vesicoureteral reflux can range from mild to severe. Mild cases usually do not cause problems and do not require treatment. Children with more severe cases may have more frequent urinary tract infections (UTIs), especially kidney infections (pyelonephritis). When a UTI involves the kidneys, it may lead to scarring and kidney damage.

What are the causes?

This condition may be caused by:

• A birth defect that affects the way the ureters connect to the bladder (primary vesicoureteral reflux).
• A blockage that prevents the normal flow of urine through the urinary tract (secondary vesicoureteral reflux).

What increases the risk?

The following factors may make your child more likely to develop this condition:

• Having a family history of the condition.
• Being female.
• Being an infant or young child.

What are the signs or symptoms?

Some children will not have any symptoms. If a child has symptoms, they are usually related to a UTI. Common symptoms of a UTI include:

• Frequent urination.
• Pain or a burning sensation with urination.
• An urgent need to urinate.
• Blood in the urine.
• Bed-wetting or other wetting accidents.
• Fever.
• Back pain or pain in the lower abdomen.

How is this diagnosed?

Your child’s health care provider may suspect vesicoureteral reflux if your child has a UTI or repeated UTIs. This is especially true if the UTI occurred with a fever or if it involved the kidneys. In some cases, a health care provider may suspect this condition if an ultrasound during pregnancy showed possible problems with the urinary system before the child was born.

This condition is diagnosed based on:

• Your child’s medical history.
• A physical exam.
• Urine tests and blood tests.
• An ultrasound of the kidney and urinary tract.
• Voiding cystourethrogram (VCUG). In this test, X-rays are taken of the urinary tract while your child is urinating. A dye (contrast medium) is put into the bladder and urinary tract so that they can be seen more clearly.
• Nuclear cystogram. In this test, your child will be given a small amount of radioactive material through a tiny tube (catheter) that is gently inserted into his or her bladder. A special camera, called a gamma camera, is used to take pictures as the bladder fills and while it empties.

How is this treated?

Vesicoureteral reflux often goes away on its own with time, especially if it was caused by a birth defect. In some cases, treatment may include:

• Antibiotic medicines to control or prevent UTIs.
• Medicines to help improve bladder control.
• Bladder training. This involves teaching your child to urinate regularly and have regular bowel movements.
• Surgery. This is done only in severe cases. It may involve:
  • Techniques to increase the length of the ureter.
  • Inserting a gel-like material to reinforce the valve where the ureter meets the bladder.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• If your child was prescribed an antibiotic medicine, give it to your child as told by your child’s health care provider. Do not stop giving the medicine even if your child starts to feel better.
• Do not give your child aspirin because it has been associated with Reye syndrome.

Preventing UTIs

• To help prevent UTIs, have your child:
  • Empty his or her bladder often and avoid holding urine for long periods of time.
  • Empty his or her bladder completely during urination.
  • Avoid bubble baths or soaking in a tub with shampoos or soaps in the bath water. These substances may irritate the urethra and can contribute to developing a UTI.
  • Drink enough fluid to keep his or her urine pale yellow.
• If your child is female, teach her to wipe from front to back after a bowel movement. Each tissue should be used only once.

General instructions

• Follow instructions on bladder training. Ask your child’s health care provider about keeping a bladder diary.
• Do not scold your child if he or she has a bed-wetting or other wetting accident.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if your child:

• Has symptoms of a UTI.
• Has swelling of the eyes, face, ankles, or feet.
• Is making very little urine.
• Is very tired or is sleeping much more than usual (lethargy).
• Has a loss of appetite.

Get help right away if:

• Your child is confused or is difficult to wake up.
• Your child who is younger than 3 months old has a temperature of 100.4°F (38°C) or higher.

Summary

• Vesicoureteral reflux is a condition in which urine from the bladder goes back into the tubes that connect the kidneys to the bladder (ureters). In severe cases, urine may flow back through the ureters and into the kidneys.
• Children with more severe cases of this condition may have more frequent urinary tract infections (UTIs), especially kidney infections (pyelonephritis).
• Vesicoureteral reflux often goes away on its own with time, especially if it was caused by a birth defect. In some cases, treatment may include antibiotics, other medicines, bladder training, or surgery.