Vesicoureteral Reflux

What is Vesicouretral Reflux?

Urine is “waste fluid” excreted by the kidneys. Urine passes from kidneys down the ureters and into the urinary bladder. The bladder is an elastic muscle that acts as a storage tank. As the bladder fills, its walls relax to hold more urine, and the control (sphincter) muscle remains tight to prevent leakage of urine. Normally the urine is prevented from going back up the ureters toward the kidneys by a valve where the ureters and bladder meet. When the valve is inadequate and allows urine to flow back up into the ureters, this condition is known as reflux. About one out of three children who have urinary tract infections are found to have reflux. Reflux is a condition people are born with and it tends to run in families. If your child has reflux, other siblings may have a 7% – 43% risk of having reflux, depending on the age of the sibling. It may suggest that other family members also be checked for reflux.

Is Reflux Dangerous?

Most urinary tract infections stay in the bladder. When a child has reflux, the bacteria have direct access to the kidneys and cause a kidney infection (pyelonephritis). This can result in damage to the kidneys and, in some other children, early onset of hypertension.

How Do I Know My Child Has Reflux?

The diagnosis of reflux is made by a bladder X-ray called a voiding cystourethrogram (VCUG). During the test a small tube is put into the urethra and a fluid (contrast media or isotope) flows into the bladder. X-ray pictures are then taken to check for reflux. Your child will be awake during the VCUG and may experience some discomfort but will not need medication for pain. If your child has reflux:

  • A kidney (isotope renal) scan or X-ray (IVP) may be done to check how well the kidneys are working and to look for kidney damage.
  • A sonogram may be done to check the size of the kidneys and to be able to follow future renal growth and to observe for scarring.
How Is Reflux Treated?

The plan of treatment will vary according to your child’s age, number of urinary tract infections and X-ray findings. Reflux is “graded” on a scale of one through five: one is the mildest and five is the most severe. In children with mild to moderate grades of reflux (grades 1-3) there is an excellent chance that the reflux will disappear as your child gets older. Treatment is aimed at preventing urinary tract infections when reflux and urinary tract infection are both present.

Children With Grade 1-3 Reflux

Most children have a good chance of outgrowing this condition as the ureteral valve matures.

  • Take low dose of an antibiotic nightly for as long as the child has reflux.
  • Have urine cultures done on a regular basis.
  • Undergo VCUG every 12 to 18 months to check if reflux has disappeared.
  • Have a sonogram of the kidneys to check for growth every 1 to 2 years.
Children With Grades 4-5 Reflux or UTIs While on Antibiotic Medication

Have surgery to correct the reflux. This type of surgery is highly successful and safe.