Vesicoureteral Reflux  (VUR)

What is vesicoureteral reflux?

Vesicoureteral reflux (VUR) is when urine flows backwards from the bladder into the ureters (the tubes that connect the bladder to the kidneys). Sometimes the backward flow of urine may reach the kidneys. VUR is most often found in infants and young children.

VUR can range from mild to severe. There are two main types of VUR:

• Primary VUR is the most common in children. In this type, the child is born with a problem with a ureter so that it allows urine to flow backwards. It can affect one or both ureters.
• Secondary VUR may be caused by a blockage in the urinary tract or when nerves in the bladder don't work well. This type of VUR usually occurs in both ureters.

What are the signs and symptoms of VUR?

VUR, on its own, does not have symptoms. However, VUR is commonly found in children who are prone to urinary tract infections that present with high fevers. Sometimes, VUR is found during screening tests for children who have hydronephrosis (swelling of the kidney).

What causes VUR?

Primary VUR is caused by a ureter that does not insert into the bladder correctly. This occurs during the baby's development in the mother's belly. Because it often runs in families, experts think it may have a genetic cause.

Secondary VUR can have many causes. These can include a blockage in the urinary tract, neurological conditions or injuries that affect the bladder, or, in rare cases, very poor bladder emptying habits by the child.

How is VUR treated?

Your child's treatment will depend on the cause of the VUR and its severity. The Division of Urology at Arkansas Children's is experienced in treating VUR and will work with you to come up with the best treatment plan for your child.

For many children with primary VUR, the condition improves over time and can be managed with simple measures. More invasive intervention to correct VUR is reserved for children with persistent febrile UTIs or kidney injury.

Children with secondary VUR are treated for the underlying condition causing the VUR, such as treatment for the urinary blockage or neurological problem.

Possible treatment options may include:

• Antibiotics to prevent urinary tract infections
• Observation to watch the condition over time with routine kidney imaging
• Surgery to correct an abnormal ureter or prevent urine backflow