Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder into the kidney.
Urine normally flows from the kidneys, through tubes called ureters, then into the bladder. Each ureter has a one-way valve where it enters the bladder, preventing urine from flowing back up the ureter. When these valves do not work properly, or 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 backup can also put extra pressure on the kidney, which may damage it.
This is a potentially serious condition that requires care from your doctor. The sooner VUR is treated, the more favorable the outcome. If you suspect you or your child has this condition, contact your doctor immediately.
This condition may be caused by:
- Defective vesicoureteral valves
since birth
- A ureter that does not extend far enough into the bladder
-
Recurrent
urinary tract infections
- Kidney stones
that reach the bladder
- Bladder outlet obstruction (e.g., blockage of urine flow from an enlarged prostate gland)
- Neurogenic bladder (loss of normal bladder function due to damaged nerves reaching the bladder)
- Temporary swelling after kidney transplant
The following factors increase your chances of developing VUR. If you have any of these risk factors, tell your doctor:
- Family history
- Congenital abnormalities of the urinary tract
-
Birth defects which affect the spinal cord, such as
spina bifida
- Tumors in the spinal cord or pelvis
- Spinal cord injury
If you experience any of these symptoms, do not assume it is due to VUR. These symptoms may be caused by other, less serious health conditions. However, if you experience any of them, see your physician.
- A bladder infection in males
- Repeat bladder infections in females
- Persistent pain in the side, back, or abdomen
- Need to urinate more frequently
- Need to urinate at night
- Burning or stinging during urination
- A feeling that the bladder is never completely empty
- Blood in the urine
- Dark or foamy urine
- Difficulty starting urine flow
- Nausea
- Vomiting
- Fever
- Chills
In some cases, VUR produces no obvious symptoms or signs.
Your doctor will ask about your symptoms and medical history, and perform a physical exam. In rare cases, high blood pressure may be an indication of kidney damage due to longstanding VUR. Tests may include the following:
- Blood Tests
: to assess how well the kidneys are functioning
- Urine Tests
: to look for evidence of an infection or damage to the kidneys
- Ultrasound
: a test that uses sound waves to examine the kidney and bladder
- CT Scan
: a type of x-ray that uses computers to make pictures of structures inside the body
- 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 emptying
- Intravenous Pyelogram
: a liquid that can be seen on x-rays is injected into a vein; x-ray images are taken as the substance travels from the blood into the kidneys and bladder
- Nuclear Scans
: a variety of tests using radioactive materials injected into a vein or the bladder to show how well the urinary system is working
The goal for treatment of VUR is to prevent any permanent kidney damage from occurring. Treatment options include the following:
Observation
: Most cases of VUR in children clear up on their own, as the ureters continue to develop. The treatment may involve regular urine cultures, antibiotics, and annual check-ups on kidney functions to follow development. Children are advised to stay well hydrated and frequently empty their bladders.
Ureteral Re-implantation
: Surgery is performed to diminish reflux by repositioning the ureters in the bladder.
To help reduce your chances of developing VUR and its associated complications, seek prompt treatment for recurrent bladder infections (or any bladder infections in males). This is particularly true if you have a neurogenic bladder.
