Vesicoureteral reflux occurs when urine dwelling in the bladder flows back into the ureters and often back into the kidneys. The bladder is the hollow, muscular organ that stores urine before urination occurs. The bladder has three small openings; two connect the ureters where urine is drained down from the kidneys, and one connects the bladder to the urethra where urine exits the body.
The ureters are funnel-shaped tubes that carry urine from the kidneys. Ureters enter the bladder at a diagonal angle and have a special one-way valve system that normally prevents urine from flowing back up the ureters in the direction of the kidneys. When a child has vesicoureteral reflux, the mechanism that prevents the back-flow of urine does not work, allowing urine to flow in both directions. This condition is most frequently diagnosed in infancy and childhood. A child who has vesicoureteral reflux is at risk for developing recurrent kidney infections, which, over time, can cause damage and scarring to the kidneys.
There are many different reasons why a child may develop vesicoureteral reflux. Some of the more common causes include:
The following are the most common symptoms of vesicoureteral reflux. However, each child may experience symptoms differently. Symptoms may include:
The symptoms of VUR may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.
VUR can often be detected by ultrasound before a child is born. If there is a family history of VUR, but your child has no symptoms, your child's physician may elect to perform a diagnostic test to rule out VUR. Diagnostic procedures for VUR may include:
VUR can occur in varying degrees of severity. It can cause mild reflux, when urine backs up only a short distance in the ureters. Or, it can cause severe reflux leading to kidney infection(s) and permanent kidney damage. Specific treatment for VUR will be determined by your child's physician based on:
Your child's physician may assign a grading system (ranging from 1 to 5) to indicate the degree of reflux your child has. The higher the grade, the more severe the reflux.
Most children who have grade 1 through 3 VUR do not need any type of intense therapy. The reflux resolves on its own over time, usually within five years. Children who develop frequent fevers or infections may require ongoing preventive antibiotic therapy and periodic urine tests. Surgical treatment is also available.
Children who have grade 4 and 5 reflux may require surgical intervention. During the procedure, the surgeon will create a flap-valve apparatus for the ureter that will prevent reverse flow of urine into the kidney. In more severe cases, the scarred kidney and ureter may need to be surgically removed.
New treatments are being introduced for vesicoureteral reflux. Consult your child's physician for more information.
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Online Resources of Kidney and Urinary Disorders