Understanding Vesicoureteral Reflux (VUR) in Children: Causes, Symptoms, and Treatment Options

Vesicoureteral reflux (VUR) is a condition that affects some children's urinary systems. In this blog post, we will answer some common questions about VUR, such as what it is, what causes it, how it is diagnosed, and how it is treated. We will also provide some background information on the normal function of the urinary system and the possible complications of VUR.

What is the urinary system and how does it work?

The urinary system consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs that filter the blood and produce urine. The urine travels from the kidneys through thin tubes called ureters to the bladder, which is a muscular sac that stores urine until it is ready to be eliminated. The urine leaves the body through another tube called the urethra.

The urinary system has a one-way valve system that prevents urine from flowing back up from the bladder to the ureters and kidneys. This helps prevent infections and damage to the kidneys.

What is vesicoureteral reflux (VUR)?

Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder to the ureters and sometimes to the kidneys. This can happen because of a problem with the valve system or because of abnormal pressure in the bladder.

VUR can increase the risk of urinary tract infections (UTIs), which are infections of any part of the urinary system. UTIs can cause symptoms such as pain or burning when urinating, frequent or urgent urination, fever, and back pain. UTIs can also spread to the kidneys and cause kidney infections, which can be more serious and lead to kidney damage or scarring.

VUR can also cause hydronephrosis, which is swelling of the kidneys due to urine buildup. Hydronephrosis can affect kidney function and growth.

What causes VUR in children?

VUR can be present at birth (congenital) or develop later in life (acquired). Congenital VUR is more common and is usually caused by a defect in the valve system that allows urine to flow back up. This defect may be inherited or occur by chance. Acquired VUR is less common and is usually caused by a problem with the bladder that prevents it from emptying normally, such as a blockage, nerve damage, or muscle weakness.

Some factors that increase the risk of VUR in children are:

- Having a family history of VUR

- Being born with a neural tube defect like spina bifida

- Having other urinary tract problems, such as posterior urethral valves, ureterocele, or ureter duplication

- Being white

- Being female

How is VUR diagnosed in children?

VUR can be diagnosed before birth by an ultrasound that shows kidney swelling or fluid in the ureters. After birth, VUR can be diagnosed by a test called a voiding cystourethrogram (VCUG), which uses X-rays to show how urine flows in the urinary system. A VCUG involves inserting a thin tube (catheter) into the urethra and filling the bladder with a liquid dye that can be seen on X-rays. The X-rays are taken as the bladder fills and empties. The test can show if there is any backward flow of urine into the ureters and kidneys.

A VCUG is usually done if:

- A child has had one UTI with fever and a kidney ultrasound shows a problem

- An infant or young child under 2 years who has had 2 or more UTIs with fever

Other tests that may be done to diagnose VUR or check for complications are:

- Renal ultrasound: A painless test that uses sound waves to create images of the kidneys and ureters

- Blood tests: To check for signs of infection or kidney function

- Urine tests: To check for signs of infection or blood in the urine

How is VUR treated in children?

The treatment of VUR depends on several factors, such as:

- The severity of VUR

- The age of the child

- The frequency and severity of UTIs

- The presence of kidney damage or scarring

- The preference of the child and family

The main goals of treatment are to prevent UTIs, protect the kidneys from damage, and correct the underlying cause of VUR.

Some possible treatment options are:

- Antibiotics: To prevent or treat UTIs by killing bacteria in the urine. Antibiotics may be given daily as a low dose for prevention or as a higher dose for treatment.

- Surgery: To repair or replace the valve system that prevents urine from flowing back up. Surgery may be done by open surgery, laparoscopy, or endoscopy. Surgery may also be done to remove any blockages or abnormalities in the urinary tract.

- Endoscopic injection: To inject a substance into the bladder wall near the ureter opening to create a bulge that acts as a valve. This is done through a thin tube (endoscope) that is inserted into the urethra and bladder.

- Observation: To monitor the child's condition with regular tests and check-ups. Observation may be chosen for mild cases of VUR that are expected to resolve on their own as the child grows.

What are the possible complications of VUR?

VUR can cause complications such as:

- Recurrent UTIs: These can cause discomfort, fever, and kidney infections.

- Kidney damage or scarring: These can affect kidney function and growth, and increase the risk of high blood pressure or kidney failure in the future.

- Hydronephrosis: This can affect kidney function and growth, and increase the risk of kidney stones or infections.

How can I help my child with VUR?

Some ways to help your child with VUR are:

- Follow your healthcare provider's instructions for treatment and follow-up care

- Give your child antibiotics as prescribed and complete the course

- Encourage your child to drink plenty of fluids to flush out bacteria and prevent dehydration

- Teach your child good hygiene habits, such as wiping from front to back after using the toilet, washing hands before and after using the toilet, and changing underwear daily

- Avoid constipation by giving your child a balanced diet with enough fiber and fluids

- Seek medical attention if your child has symptoms of a UTI, such as pain or burning when urinating, frequent or urgent urination, fever, or back pain