Dr. MJ Bazos Md,
Urine normally flows in one direction—down
from the kidneys, through tubes called ureters, to the bladder. Vesicoureteral
reflux (VUR) is the abnormal flow of urine from the bladder back into the
VUR is most commonly
diagnosed in infancy and childhood after the patient has a urinary tract
infection (UTI). About one-third of children with UTI are found to have VUR. VUR
can lead to infection because urine that remains in the child's urinary tract
provides a place for bacteria to grow. But sometimes the infection itself is the
cause of VUR.
There are two types of
VUR. Primary VUR occurs when a child is born with an impaired valve where the
ureter joins the bladder. This happens if the ureter did not grow long enough
during the child's development in the womb. The valve does not close properly,
so urine backs up (refluxes) from the bladder to the ureters, and eventually to
the kidneys. This type of VUR can get better or disappear as the child gets
older. The ureter gets longer as the child grows, which improves the function of
Secondary VUR occurs when
there is a blockage anywhere in the urinary system. The blockage may be caused
by an infection in the bladder that leads to swelling of the ureter. This also
causes a reflux of urine to the kidneys.
Infection is the most common symptom
of VUR. As the child gets older, other symptoms may appear, such as bedwetting,
high blood pressure, protein in the urine, and kidney failure.
Common tests to show the presence of
urinary tract infection include urine tests and cultures. Pictures of the
urinary system (cystourogram) may then be needed to determine whether a
defective structure in the urinary tract is the underlying cause of the VUR and
The goal for treatment of
VUR is to prevent any kidney damage from occurring. Infections should be treated
at once with antibiotics to prevent the infection from moving into the kidneys.
Antibiotic therapy usually corrects reflux caused by infection. Sometimes
surgery is needed to correct primary VUR.