VESICO URETERAL REFLUX (VUR)
Last Updated : 1/13/2011
Kumud P Mehta
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My daughter aged 5 years gets repeated urinary infections. I have been told that she has VUR. What is VUR?
VUR is a short form of vesicoureteral reflux which means that urine from the urinary bladder regurgitates or goes back into the ureters (the tubes
that connect kidneys to urinary bladder) instead of flowing out of the urethra (tube that allows flow of urine to the outside form the bladder). In severe cases the urine which is in the bladder reaches back in the kidneys.

Why does VUR occur?
VUR occurs either as a defect in the development of opening of ureter in the urinary bladder from birth when it is called as primary VUR, or secondary due to the obstruction in the bladder or urethra which causes back pressure and opens the junction/s between bladder and ureters.

How does my doctor diagnose VUR?
VUR is definitely and accurately diagnosed by a special X-ray test named as micturating or voiding cystourethrogram (MCU/VCU).

Apart from repeated urinary tract infections (UTI), does VUR cause any other problem?
Repeated urinary tract infections along with VUR can damage the kidney/s leading to high BP, kidney failure and in young females complications during pregnancy i.e. toxemia of pregnancy.

How significant a problem is VUR?
The incidence of VUR is as high as 1:200 births. Mild grades of VUR (Grades I & II) resolve within first 5-years after birth and no damage to kidneys occur in these cases. High grades of VUR (Grades III, IV, V) can cause the above mentioned complications.

Can a patient still have a VUR even if he/she has never had a urinary tract infection? If yes, then how can it be diagnosed?
VUR is present as a birth defect and urinary infection brings VUR to the doctor’s attention. It is suspected in cases with recurrent urinary tract infection. It can be familial and should be looked for in brothers, sisters and parents of a child with VUR. Ultrasonography is a simple method of diagnosing VUR of Grades III-IV.

Can VUR be detected before birth?
Antenatal USG of unborn babies may show dilatation of urinary system from kidney pelvis, ureters etc.

Can VUR disappear on its own or does it require treatment?
As mentioned earlier, mild grades of VUR disappear on their own. Every 2 – 3 years, 20 – 30% of VUR resolve. Till VUR disappears, it is better to check urine for infection and treat it because combination of VUR and UTI is damaging to the kidneys.

What is the treatment for VUR?
Treatment of VUR of high grades - IV-V is surgical correction by ureteric reimplantation. VUR of grades II & III can be treated by medicines to control and prevent urinary infections (medical treatment)

My child is taking antibiotics since a long time, yet the VUR has increased. Why is it so?
If VUR increases inspite of taking antibiotics for a long time either the drug is not appropriate or the child requires surgery.

Is MCU the only way to detect VUR or are there other ways also?
Initially MCU is the only way to diagnose VUR. Other methods like Doppler USG are not very accurate and cannot grade VUR properly

When would surgery be required? What is the surgery?
Surgery for VUR is indicated if long term antibiotic therapy fails to control UTI, or VUR is grade IV-V or child does not take medicines and mother is apprehensive about the complications of VUR.

Surgery repairs the defect by forming a tunnel through bladder wall and creating a new opening for the ureter/s which will stop regurgitation of urine towards the kidneys.

Will my child have any problems as an adult?
As a rule if VUR is diagnosed before urinary tract infection occurs or if recurrent UTI is prevented by medications or if VUR is surgically corrected, no major problems are expected as an adult.

How often should I go to my doctor if my child has VUR?
Yearly follow up with weight, height, BP, urine examination, renal function tests are needed even if the child has no symptoms till he/she grows upto 20-25 years of age.

Can stones cause VUR?
No stones do not cause VUR unless they cause obstruction of bladder.

Is there any other intervention (dietary etc.) that can help?
No dietary intervention helps in treatment of VUR.

My child has VUR. What is the prognosis?
Prognosis is good if prompt diagnosis, appropriate drug therapy and timely surgery is performed when needed. Long-term follow up is essential without defaulting to get good outcome of VUR.



Contributor Information and Disclosures

Kumud P Mehta
Consultant Pediatrician & Pediatric Nephrologist, Jaslok Hospital & Research Centre, Bai Jerbai Wadia Hospital for children, Mumbai, India


First Created : 1/3/2011

References

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