Vesicoureteral reflux (VUR) is the backward flow of urine from the
bladder into the
kidneys. Normally, urine flows from the kidneys
ureters to the bladder. The muscles of the bladder and
ureters, along with the pressure of urine in the bladder, prevent urine from
flowing backward through the ureters.
VUR allows bacteria, which
may be present in the urine in the bladder, to reach the kidneys. This can lead
kidney infection, scarring, and damage.
There are two
types of VUR:
urinary tract infection (UTI) can be a symptom of VUR.
About one-third of children who are diagnosed with a UTI have VUR.1 Symptoms of a UTI may include fever, pain or burning with
urination, frequent urination, and the feeling that the bladder does not empty
completely. Fever may be the only symptom of a UTI in a small child. So a
urinary tract infection should be suspected in any child who has a high fever
without an obvious cause.
VUR is usually diagnosed
when a urinary tract infection (UTI) is suspected. Your doctor will ask about
the history of your child's symptoms and do a physical exam.
following tests may be recommended if UTI is suspected:
VUR can be passed down from parent to child (inherited).
If one of your children has VUR, you may want to ask your doctor to check if your other
children have it too. Checking for VUR in siblings is especially helpful if your other child also has urinary tract infections. Doctors can use a cystourethrogram to see if babies
who have a sibling or parent with VUR also have the condition. But experts
disagree about screening for VUR, because the test involves going into the
Many children do not
need treatment for vesicoureteral reflux. The ureters grow as a child gets
older. Mild cases of VUR usually go away completely by the time a child is 5
If treatment is needed,
antibiotics, such as amoxicillin or trimethoprim-sulfamethoxazole (for example,
Bactrim), are often prescribed. Antibiotics prevent or treat
infection and help reduce the chance of scarring that can lead to kidney
damage. Your child may need to take continuous antibiotic treatment. Or your doctor may give you the option of carefully watching your child for signs of another urinary tract infection and only using antibiotics when he or she gets a new infection. Frequent tests may be needed to check for bacteria in the urine.
Surgery may be needed to repair more severe cases of VUR. A surgeon may
need to create new valves for the ureters to prevent the backflow of
Surgery may also be needed if your child has repeated
urinary tract infections while taking antibiotics or is not able to take
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Tanagho EA, Nguyen HT (2013). Vesicoureteral reflux. In JW McAninch, TF Lue, eds., Smith and Tanagho's General Urology, 18th ed., pp. 182–196. New York: McGraw-Hill.
Other Works Consulted
American Urological Association (2010). Management and screening of primary vesicoureteral reflux in children: AUA guideline. Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm.
Garin EH, et al. (2006). Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: A multicenter, randomized, controlled study. Pediatrics, 117(3): 626–632.
Halachmi S, Pillar G (2008). Congenital urological anomalies diagnosed in adulthood: Management considerations. Journal of Pediatric Urology, 4(1): 2–7.
Khoury AE, Bägli DJ (2012). Vesicoureteral reflux. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 4, pp. 3267–3309. Philadelphia: Saunders.
Lum GM (2012). Kidney and urinary tract. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 717–739. New York: McGraw-Hill.
January 13, 2011
E. Gregory Thompson, MD - Internal Medicine
& Christopher G. Wood, MD, FACS - Urology, Oncology
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