Vesicoureteral Reflux

Overview

Urine is the waste produced by your body at the end of various reactions happening inside your body. The normal course of movement that urine follows in your body is from the kidneys, where the urine is produced through the ureters , to your urinary bladder. It is finally excreted through your urethra.

In Vesicoureteral Reflux, the urine flow is reversed, i.e., the urine flows from the urinary bladder to your kidneys. This condition can arise because of various reasons. It is very commonly seen in infants and young adults. In fact, around 10% of infants are diagnosed with this condition.

Children might outgrow primary vesicoureteral reflux, and no treatment might be needed. However, it is advisable to meet your doctor immediately if you observe symptoms.

What are the Causes of Vesicoureteral Reflux?

Urine is formed in your kidneys. All the related organs, such as the urinary bladder, the ureters (tubes), and the urethra, including your kidneys, form your urinary system. They play a role in helping your body excrete urine.

Ureters help pass urine from the kidney to your urinary bladder. In vesicoureteral reflux, the direction of urine flow is reversed, leading to the flow of urine from the urinary bladder to the kidneys.

What are the Types of Vesicoureteral Reflux?

Vesicoureteral reflux is of two types, depending on the nature of the origin of the condition:

• Primary Vesicoureteral Reflux: This condition is usually congenital, i.e., present from birth. Patients with this condition have a defect in the valve present at the junction where the ureters and urinary bladder join.

This valve helps prevent the backflow of urine from the urinary bladder to the kidneys. The defect in the valve leads to the backflow of urine. This is the more common type. Infants and young children are affected by this type of vesicoureteral reflux.

As your child grows, the ureter straightens and lengthens, with the valve growing stronger. This might help your child outgrow the condition and eventually correct the defect.

This condition generally affects members of a family. Hence, it is mostly genetic, but the exact cause is unknown.

• Secondary Vesicoureteral Reflux: This condition arises when there is a problem in the emptying of your urinary bladder, which leads to urine accumulation. Due to this complication, there is reflux. Problems in the emptying of the bladder may arise due to a defect in the muscles of the bladder or the nerves controlling the emptying of the bladder.

What are the Symptoms of Vesicoureteral Reflux?

A common complication of vesicoureteral reflux is Urinary Tract Infections (UTIs). Though signs and symptoms of UTIs might not be noticeable at first, some symptoms include:

• Fever. 
• Pain while urinating. 
• A burning sensation while urinating
• A strong and continuous urge to urinate. 
• Pain in the side of your abdomen. 
• Cloudy urine. 
• The urge to pass small amounts of urine.  

If left untreated, vesicoureteral reflux might cause the following symptoms:

• Frequent bedwetting.
• Hypertension (high blood pressure).
• Presence of protein in the urine.

When Should You See Your Doctor Regarding Vesicoureteral Reflux?  

Since the most common complication of vesicoureteral reflux is urinary tract infections, you should immediately see your doctor if your child is starting to show the symptoms of UTI. They are: 

• An unexplained fever. 
• Sudden change in mood.
• Frequent bedwetting. 
• Pain in abdomen flanks (sides).
• Cloudy urine.

You should contact your doctor at the earliest if your child is older than 2 months and is showing a rectal temperature of more than 100.4 F (38 C).

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What is the Treatment for Vesicoureteral Reflux?

Based on the width of the ureters and how far the urine backs up in the ureters, vesicoureteral reflux is graded one through five, with five being the most severe form of vesicoureteral reflux.

Based on the grading, your physician could take a wait-and-see approach and observe the condition. This is because children can outgrow primary vesicoureteral reflux.

Until then, your doctor may prescribe some antibiotics to fend off or treat urinary tract infections if already present. It is essential that these antibiotics be taken as prescribed, even if infections are not present, as severe UTIs can cause kidney and bladder damage. Prevention is better than cure.

If your child does not respond to medications and there is definite kidney scarring due to UTIs, your doctor may prescribe surgery as the next option.

Surgical repair methods include

• Open surgery: The surgery, done using general anesthesia, needs a cut/incision in the lower abdomen through which, the physician repairs the problem. 
• Robotic-assisted laparoscopic surgery: Like open surgery, in this surgery valve between the ureter and the bladder is repaired. However, the procedure is performed using small cuts/incisions.
• Endoscopic surgery: This procedure involves inserting a lighted tube called cystoscope through the urethra to see inside the bladder of your child. Then, a bulking agent is injected around the opening of the affected ureter to try and strengthen the valve’s ability to close properly. 

A substance called  Deflux is injected near the valves of the ureter, providing support to the valves so that the reflux of urine is reduced. The Deflux gel is broken down by the body and is replaced by the tissues serving the same purpose.

Secondary vesicoureteral reflux can be treated by the following methods

• By treating the underlying condition causing the muscle damage or nerve damage in the bladder.
• Antibiotics to treat UTIs.
• By frequently emptying the bladder through catheterization.

Can You Prevent Vesicoureteral Reflux?

There is no known way to prevent vesicoureteral reflux. But one can ensure the health of their child’s urinary tract by following these simple steps:

• Ensure that your child drinks large amounts of water.
• Ensure you get any bowel/bladder disease checked immediately. 
• Ensure that your child urinates regularly.

Vesicoureteral reflux is a common complication that affects about 10% of children. Hence, it is not a reason to panic or worry. Its treatment is not complicated and is extremely safe. Just ensure to look for signs or symptoms your child might present with and contact your doctor at the earliest.

Frequently Asked Questions (FAQs)

Q. What kind of tests are required to diagnose Vesicoureteral Reflux?

Some tests required to diagnose vesicoureteral reflux are

• Kidney and bladder ultrasound. 
• Specialized X-ray of urinary tract system. 
• Nuclear scan. 

Q. Who is more likely to get vesicoureteral reflux?

People with bowel/bladder diseases are more likely to develop vesicoureteral reflux. Generally, girls are at a larger risk of getting vesicoureteral reflux. If your family has a history of vesicoureteral reflux, your child is at a higher risk. Abnormal urinary bladder and congenital kidney abnormalities can put your child at a higher risk.

Q. Is it recommended that my child sees a specialist?

Doctors usually discover VUR as part of follow-up treatment to UTIs. After diagnosis, your child may be referred to a doctor specializing in urinary tract conditions (urologist) or kidney conditions (nephrologist).