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In a healthy urinary tract system, a child’s urine flows in one direction: downward from the kidneys, through the ureters and into the bladder. From there, urine leaves the body when we urinate. Vesicoureteral reflux (VUR) is a problem that causes urine to flow backwards from the bladder into the ureters and kidneys—the opposite direction of a normal flow.
When a child with vesicoureteral reflux urinates, some urine goes back into their ureter(s) and/or kidneys. Primary VUR is a congenital condition (present at birth) caused by an abnormal connection of the ureters in the bladder. This abnormal anatomy allows urine to flow backwards.
The type of VUR and the severity of the condition determine how each child’s VUR is treated. Here is the grading system pediatric urologists use to describe VUR, from the mildest to the most severe condition:
In otherwise healthy children, an isolated urinary tract infection (UTI) is not a significant cause for concern if the infection responds to prescribed medication and never returns.
If your child has vesicoureteral reflux, he or she may be prone to recurring urinary tract infections, despite medical treatment. In children with VUR, multiple urinary tract infections (especially if associated with a fever) are a bigger problem because infected urine can travel into the ureters and/or kidneys.
These UTIs can lead to more serious infections such as pyelonephritis—an acute infection of the kidneys accompanied by a high fever and possible damage to renal (kidney) function. The kidneys are important to health for many reasons—mainly because they remove waste from the body and balance fluids.
Children who have recurrent UTIs with a fever over 101.5°F warrant the most concern. Their UTIs may resemble an isolated urinary tract infection with urgent or frequent peeing, pain, incontinence and blood in the urine. Repetition of infection accompanied by a high fever suggests a more serious infection involving the kidneys.
Diagnosis of vesicoureteral reflux starts with urinalysis, a urine culture and possibly some blood tests. Based on these test results, pediatric urologists at Riley at IU Health may order a renal ultrasound to check for structural abnormalities in the urinary tract.
If the ultrasound is normal and your child is otherwise healthy, we may monitor your child to see if the problem resolves on its own. Unless another serious infection follows, no further tests may be needed.
If your child is very young, very sick or has an abnormal ultrasound, such as swelling in the kidneys or ureter (also called hydronephrosis), your physician may order a special test called a voiding cystourethrogram (VCUG). Typically, the VCUG is only needed for children who have had recurrent febrile urinary tract infections. (Febrile means the infections are accompanied by high fevers.)
VCUG is a test that requires a catheter. Your child’s bladder is filled with a special X-ray dye that allows radiologist to evaluate the bladder for reflux of urine.
Most children are awake and tolerate a VCUG well. Our child life specialists support your child with toys, games and other distractions to help them manage the procedure with minimal pain or discomfort. The presence of a parent or caregiver may make the test easier on your child. The test takes 30 - 45 minutes and is performed by a dedicated radiology team, including an experienced radiologist who reads the images.
Children may outgrow vesicoureteral reflux. Using treatment guidelines published by the American Urological Association, our physicians may prescribe a small dose of daily antibiotic to protect children against recurrent urinary tract infections while waiting to see how a child’s development affects the condition. During that phase, we closely monitor children and help them adopt healthy voiding habits, if necessary.
In more severe cases, children are less likely to outgrow the condition. If tests show renal scarring, or if children have recurring urinary tract infections while taking antibiotics, surgery may be necessary.
Here are three common surgeries used to correct VUR:
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