Page 1 - Vesicoureteric Reflux

Urological Health
Vesicoureteric reflux
Vesicoureteric reflux is a common problem in children with urinary infections.
Surgical correction is possible in the few who will require treatment.
our child has been found to have vesicoureteric
Yreflux (VUR). This is a condition, commonly
detected during the investigation of urinary tract
infection (UTI) in children, in which urine can flow back
from the bladder toward the kidneys.
Urine produced by the kidneys drains down tubes
(the ureters) into the bladder where it is stored until it
is appropriate to empty through the urethra (“urine
passage”). Normally, one-way “flap valves” at the
junction between the ureters and the bladder prevent
backflow of urine toward the kidneys.
When these valves do not develop properly,
backwash of urine from the bladder to the ureter
and kidney, vesicoureteric reflux, can occur. One
or both kidneys may be involved from the time of
birth. Usually, VUR alone will produce no symptoms or
cause any harm. Should your child develop a bladder
infection, however, the infected urine flowing back to
the kidney(s) can cause a kidney infection. This can
make your child quite ill with fever and chills, and,
may result in permanent scarring of the kidney. In most
cases, urinary infection does not cause VUR, nor does
VUR cause urinary infection.
Investigations of VUR
Underlying urinary tract abnormalities are common
in children with urinary infections. A child who
experiences a UTI may undergo imaging studies to
demonstrate urinary tract anatomy and determine
the presence of VUR. Your doctor will recommend the
necessary investigations and their timing.
The kidneys may be examined by ultrasound, a
painless test without x-ray exposure. The identification
of VUR requires another test, the voiding cysto-
urethrogram (VCUG). A small tube (catheter) is
inserted into the child’s bladder through the urethra.
The bladder is then filled with contrast material
(“dye”) and x-rays are taken as your child voids.
The appearance of contrast in the ureter or kidney
confirms the suspicion of VUR and its severity can be
graded.
Your doctor may recommend other tests such as a
nuclear cystogram, which is carried out much like
a VCUG, but exposes your child to less radiation, or
a renal nuclear scan to accurately assess kidney
function and the presence of scars.
Preventive antibiotics
In time, VUR frequently will resolve without treatment
as the valves develop in the growing child. Many
cases of VUR can be monitored safely without specific
treatment as long as infection is prevented. During this
period of observation, your doctor may recommend
small daily doses of antibiotics in an effort to prevent
infection and kidney damage.
The severity (grade) of VUR and a child’s abnormal
voiding habits, such as prolonged urine holding,
will determine the duration of VUR. A child with
VUR should be encouraged to void regularly and
constipation should be prevented. Usually, VUR
resolves within two years for boys and four years for
girls.
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