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Would you please explain vesicoureteral reflux in children? How is it treated?
When urine is produced by our kidneys, it passes down a tube called the ureter going from each kidney into the urinary bladder. The process of urination occurs when the bladder contracts down to force the urine out through a single tube, the urethra, to the outside world. During the process of urination, the urine is normally prevented from being pushed back up through the ureters by a flap-valve where the ureters enter the bladder. If these flap-valves do not work perfectly, urine can get forced back up toward the kidneys, sometimes with quite a bit of force. This is referred to as vesicoureteral reflux (VUR). This "back-pressure" can cause serious damage to the kidneys.
This condition does not cause any pain or apparent symptoms directly. It is most often discovered because VUR tends to leads to urinary tract infections (UTI's). After a UTI, children should be watched carefully. If your doctor feels that it is necessary, tests should be done to detect VUR, as well as any damage that the UTI may have caused to the kidneys. The test to detect VUR is called a voiding cystourethrogram (VCUG). In this test, a small tube is put up into the bladder (mild sedation is often used for children during this procedure), a dye is used to fill the bladder under gentle pressure, and x-ray pictures are used to detect flow back up into the ureters. The amount of flow is graded one through four, depending of the degree of severity of the back flow. Therapy is based upon the grade of the reflux and can consist of oral antibiotics taken in very low doses (prophylactic antibiotic therapy) all the way up to surgical correction of the problem.
VUR is a significant problem because if not monitored carefully, ongoing refluxing and repeated UTI's can cause serious kidney injury and possibly kidney failure. Most of us would feel that consultation with a pediatric urologist is in order if VUR is suspected or diagnosed.
Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care
"Clinical presentation, diagnosis, and course of primary vesicoureteral reflux"