Vesicoureteral reflux (VUR) is the condition when the flow of the urine from the urinary bladder goes the wrong way. Normally, the urine flows from the kidneys via the ureters down to the bladder, but in case of Vesicoureteral reflux, the urine flows abnormally, i.e., it backs up into the tubes (ureters) that connect the kidneys to the bladder. This condition is more common among infants and young children and if not treated on time, it can cause urinary infection and eventually lead to kidney damage. Although most children are able to outgrow primary Vesicoureteral reflux, yet people who have severe cases may need surgery and medications to protect their kidneys.
Our urinary system comprises of kidneys, ureters, bladder and urethra, all of which play a vital role in removing waste products from the body in the form of urine via the ureters and then it exits the body through another tube called urethra during the process of urination.
Vesicoureteral reflux can develop in two types, primary and secondary:
Primary Vesicoureteral Reflux: Children suffering from primary vesicoureteral reflux are usually born with a defect in the valve (a flap on top of the ureter that prevents urine from flowing back into the bladder). This defect leads to abnormal back flow. But as the child grows the flap lengthens and straightens on its own, which then improves the valve function and eventually corrects the reflux condition.
Secondary Vesicoureteral Reflux: People diagnosed with this type of reflux condition generally has bladder problem i.e., failure of the bladder to empty properly, either due to a blockage or failure of the bladder muscles or due to damage to the nerves that control normal bladder emptying.
Certain causative factors that increase the risk of Vesicoureteral Reflux includes:
Age: Although it is also diagnosed in older children and adults, but infants and children up to the age of 2 are more susceptible to have this condition.
Ethnicity: White children from western countries are more prone to vesicoureteral reflux than children with a darker skin tone.
Gender: Girls have a much higher risk of having this condition than boys do but primary vesicoureteral reflux is more common in boys.
Bladder and Bowel Dysfunction (BBD): Children suffering from BBD often have a tendency to hold their urine and stool and hence experience recurrent urinary tract infections, which can ultimately lead to vesicoureteral reflux.
Spinal Problem: Children who are diagnosed with nerve or spinal cord problems such as spina bifida (a birth defect of the spine) have an aggravated chance of VUR.
Urinary Abnormalities: Children with problems in their urinary system like Bladder exstrophy (birth defect affecting urinary tracts), Ureter duplication (an extra ureter for one kidney) or Uterocele (defect in the ureters) are more at risk of having this condition.
Family History: Primary vesicoureteral reflux is often genetic in nature and are commonly seen in children whose parents also had the condition.
Many people suffering from vesicoureteral reflux often do not show characteristic symptoms till later, but the most common one that do crop up is urinary tract infection (UTI) caused by bacteria.
The symptoms involved with UTI include:
- Strong urge to urinate
- Pain or burning sensation while urinating
- Cloudy or blood in the urine
- Stinky urine
- Need to pass small amounts of urine
- Sudden, frequent urination or wetting
- Abdominal pain
Other symptoms of VUR include:
- Trouble urinating
- Mass in the abdominal area
- High blood pressure
- Presence of protein in urine
- Poor weight gain
- Lack of appetite
Diagnosis And Treatment
If you notice any of the above-mentioned symptoms in your child, do consult a doctor urgently. The doctor usually does a thorough physical check-up, acknowledges the patient’s past medical history and conducts the following diagnostics:
- Blood test
- Urine test
- Voiding cystourethogram (VCUG)
- Radionuclide cystogram (RNC)
- Abdominal ultrasound
Children with primary vesicoureteral reflux often gets resolved on its own as they grow up but severe cases require medical intervention. It chiefly includes:
- Medications including antibiotics
- Surgery including open surgery, endoscopic surgery and robotic-assisted laparoscopic surgery