Vesicoureteral Reflux (VUR) is a congenital irregularity in the formation of the ureter, which causes a backflow of urine from the bladder to the kidneys. This backflow of urine causes bacteria to grow and results in urinary tract infections (UTIs), also known as bladder infections. Normally, urine flows from the kidneys to the bladder through a long, thin tube known as the ureter. A valve that opens one way passes the urine from the ureter to the bladder, then out of the body. Often, infants are born with immature ureters that are too short, run at a slight angle, or enter the bladder in an atypical place, causing vesicoureteral reflux.
There are two types of vesicoureteral reflux, the first of which is Primary VUR. This occurs when the valve at the ureter/bladder junction is impaired or immature at birth. The valve malfunctions by failing to close the way it should, resulting in backed up urine into the ureter. Secondary VUR occurs when there is a blockage in the urinary system, possibly the result of a UTI that causes the ureter to swell, blocking it.
The result of untreated vesicoureteral reflux can be numerous UTIs and kidney damage. For this reason, vesicoureteral reflux has become an aggressively diagnosed and treated condition. Up to one-third of infants and children who have a UTI are eventually diagnosed with VUR. Fortunately, the vast majority of children with vesicoureteral reflux grow out of the condition with no later recurrence or complications.
A doctor will pursue tests to confirm vesicoureteral reflux after a newborn has his or her first UTI. For an older infant, up to one year old, tests will be ordered after the second bout of UTI, and for an older child, after a third or fourth infection. Although there are four tests that are typically part of the diagnosis, the standard of care is an ultrasound and a voiding cystourethrogram (VCUG).
An ultrasound is usually the first test conducted. It can signal the presence of certain abnormalities in the urinary tract system. This test however, is not conclusive.
With a VCUG, the child is catheterized and a liquid dye is injected into the bladder. X-rays are taken of the filled bladder and the process of urination. This test shows abnormalities of both the bladder and the urethra and reveals how urine flows through the system.
Intravenous Pyelogram (IVP) is another diagnostic test used to determine whether a child has VUR. This test looks at the urinary tract as a complete system. A liquid dye is injected into a vein where it flows into the kidneys, then the bladder. This test helps doctors locate any possible obstruction along the way.
Another test is a nuclear scan. In this test, radioactive materials are injected into a vein, and then scans are performed to see how the liquid flows through the urinary tract. Although the name sounds scary, it exposes children to as much or less radiation than a typical x-ray. The degree of a child’s vesicoureteral reflux is graded from one to five, one being the mildest amount of reflux.
Once a diagnosis is made, treatment of vesicoureteral reflux is geared toward prevention of future UTIs and possible kidney damage. The pediatrician may prescribe a low dose of prophylactic antibiotics to be taken on a daily basis for approximately six to 12 months. Usually, at a year after diagnosis, the doctor will repeat the tests to determine whether the child has outgrown the condition.
