What is Vesicoureteral Reflux (VUR)?

April 29,2021 |

Your urinary tract system’s primary function is to safely filter the blood and remove any waste products that need to be expelled out of the body. This means that urine moves through the kidneys, ureters, and into the bladder to be released through your urethra once the bladder fills. It’s a one-way street. Once the urine is in your bladder, it should stay there until it’s time to use the bathroom. In some people, this one-way street doesn’t work properly, and the urine flow gets disrupted. When you have vesicoureteral reflux (VUR), the urine in your bladder goes back up the ureter and into the kidneys.1 This condition can be particularly dangerous if left unchecked, because it makes your kidneys more susceptible to infection and chronic damage. In this article, we’ll explore everything you need to know about vesicoureteral reflux (VUR) and what to do if it isn’t naturally corrected.

Causes of Vesicoureteral Reflux

VUR is caused by one of two things. In primary vesicoureteral reflux, there’s a malfunction of the flap valve that connects ureters to the bladder.1 This flap is what creates the one-way flow, so when it doesn’t work properly urine can retreat back into the kidneys.1 This can affect either one or both ureters. In primary vesicoureteral reflux, as the body continues to grow and develop, VUR can get better and even go away completely without surgery or medical aid.2

Secondary vesicoureteral reflex is when there’s a blockage at the bladder that causes the urine flow to reverse back through the ureters.1 This could also be due to narrowing in the bladder neck or urethra or another blockage.2 Secondary vesicoureteral reflux might also occur if the nerves in the bladder aren’t functioning properly.2 In the case of secondary VUR, both ureters and both kidneys are affected.2

Risk Factors of Vesicoureteral Reflux

Vesicoureteral reflux is more common among infants and young children and affects roughly 10% of children.1 While rare, it can also affect older children and even adults. To make sure that you avoid any complications of VUR, it’s important to understand your risk factors and what to watch out for.

The biggest risk factor of vesicoureteral reflux is having abnormal kidneys or urinary tracts.2 As children, this might be because of the development process, which is why a lot of cases of VUR are corrected naturally. In non-developmental cases, VUR is often a result of a birth defect in the urinary tract system such as a short flap valve that connects the ureters with the bladder.1 Children who are born with nerve or spinal cord problems are at a greater risk of VUR.1 

Girls are more likely than boys to have VUR and a child is more likely to develop it if someone else in the immediate family has had it.2

Symptoms of Vesicoureteral Reflux

In many cases, a child who has VUR doesn’t show any symptoms other than recurrent or chronic urinary tract infections. Since VUR occurs in young children, it may be difficult to recognize when they’re experiencing signs of symptoms, so it’s important to pay close attention to potential signs of a problem. Aside from chronic UTIs, some of the symptoms of VUR include urinary incontinence, bedwetting, urinary retention, and bowel problems, such as constipation.2 You may also notice signs that a UTI are present if you notice blood in urine or cloudy, stinky urine, urinating in very small amounts, a fever, or abdominal pain.1 Trouble urinating, a mass in the abdominal area, or loss of appetite are signs of more serious problems with VUR.1 If you notice any of these symptoms, it’s important to call a doctor to make sure that the underlying cause is properly identified. 

When to See a Doctor

If the person you believe is suffering from VUR has a temperature of 102 degrees Fahrenheit, call your doctor immediately.1 This could be an indication that the infection has reached the kidneys and needs to be addressed as soon as possible.  

If you notice any signs or symptoms, call your doctor to set up an appointment. When left untreated, vesicoureteral reflux can lead to severe complications. VUR can lead to permanent kidney scarring, which could contribute to high blood pressure and kidney failure over time.4 Even without the presence of kidney scarring, high blood pressure and kidney failure are potential complications, so it’s always best to get a diagnosis and start a treatment plan before things progress.

Diagnosing Vesicoureteral Reflux

Since symptoms are easily mistaken for something else, most cases of VUR are discovered only after a child has developed a UTI and is seeking treatment.3 However, it’s very important to bring in your child, or come to the doctor, if you do notice any signs or symptoms. Your doctor can use one or more tests to properly diagnose VUR. There are different levels of VUR ranking from grade 1 through 5 with grade 5 being the most serious.2 To understand the proper course of treatment, diagnosing the severity of VUR is important.

During your regular prenatal visits, your doctor can use an ultrasound to detect VUR before birth.1 An ultrasound can also be used on children to get a glimpse of their urinary tract system without exposing them to high levels of radiation.2 In this case, an abdominal ultrasound will be performed and your doctor will look for any signs that your child’s kidneys or ureters are dilated or widened.2 Abdominal ultrasounds are completely pain free, safe, and non-invasive.

Another commonly used test is the voiding cystourethogram (VCUG) test.1 This test takes x-ray images of the bladder and urethra to show the direction of the urine flow.2 To perform a VCUG test, your doctor will need to fill your child’s bladder with a special dye before the x-ray. Then, a technician will take x-rays before, during, and after your child urinates.2 VCUG tests use a smaller amount of radiation than traditional x-rays and anesthesia isn’t needed.2 However, some children may be scared or unnerved, so your doctor may offer a mild sedative to help them with the test. A radionuclide cystogram (RNC) is similar to a VCUG, but the dye is a radioactive material that is then detected by a nuclear scan.1 Talk to your doctor about diagnosing tests before their performed so that you understand all of the risks and processes completely.

Other diagnostic tests that may accompany an abdominal ultrasound or a VCUG include urodynamics tests, blood tests, and a urinalysis.

How to Treat Vesicoureteral Reflux

If you or your child have been diagnosed with VUR, your doctor will determine your treatment plan based on the severity of the VUR (grade 1 through grade 5).1 If you have grade 1 or grade 2 VUR, it’s more likely to go away on its own without treatment. The more severe that your VUR is, the higher chances that you’ll need external treatments.

If you or your child has primary vesicoureteral reflux, it’s more likely to get better on its own without aid. During this process, your doctor will supply antibiotics to treat any UTIs that occur before they get too serious. If suffering from chronic UTIs, your doctor may prescribe a long-term, low-dose antibiotic to help prevent UTIs and avoid serious complications.2 If the UTIs have caused renal scarring or severe reflux, your doctor may recommend surgery to correct primary VUR and avoid further complications. In some instances, doctors will treat VUR by using bulking injections.2 This works by injecting a small amount of gel-like liquid into the bladder wall near the opening of the ureter, which creates a bulge that acts like a valve to the ureter.2 It’s an outpatient procedure, but does require general anesthesia.

Treating secondary VUR is similar to treating primary VUR in that your doctor may recommend antibiotics to prevent or treat UTIs. However, since secondary VUR is caused by a blockage or irregularities in the urinary tract system, your doctor may recommend surgery to remove to blockage or correct an abnormal bladder or ureter. In serious cases of secondary VUR, your doctor may recommend using intermittent self-catheterization.

Conclusion

If you notice any signs or symptoms of vesicoureteral reflux in either yourself or your child, call your doctor today. The best way to avoid any serious problems or complications is through proper diagnostic testing and treatment plans. If you need any urological supplies or educational resources, don’t forget to visit our educational support page and our product selection guide. Byram Healthcare is proud to offer full-service urological care and we have all the high-quality urological supplies that you need. If you need to order any urological supplies, all of your orders can be discreetly delivered to your home, at any time of the day. If you have any urological questions or need personalized, confidential services, our teams of knowledgeable urological customer service specialists are here to help.

Sources:

1 https://www.webmd.com/children/vesicoureteral-reflux#1

2 https://www.niddk.nih.gov/health-information/urologic-diseases/hydronephrosis-newborns/vesicoureteral-reflux

3 https://www.urologyhealth.org/urologic-conditions/vesicoureteral-reflux-(vur)

4 https://www.mayoclinic.org/diseases-conditions/vesicoureteral-reflux/symptoms-causes/syc-20378819

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