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VESICO URETERAL REFLUX (VUR)
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.
Last created on 04-12-2001
Last updated on 18-11-2006