Pediatric Urology

Vesicoureteral Reflux

Appointments

(608) 263-6420


Information For Parents From Kids Health

Recurrent Urinary Tract Infections and Related Conditions

Pediatric urologists at UW Health and American Family Children's Hospital in Madison, Wisconsin, provide complete diagnosis, consultation and surgical treatment for vesicoureteral reflux (VUR), or bladder reflux.
 
Vesicoureteral Reflux Overview
 
Vesicoureteral reflux is the backward flow of urine from the bladder toward the kidney, caused in part by an incompetent valve system between the ureters and the bladder. Bladder reflux affects about one percent of all children and is more common in girls than boys. It also tends to run in families. Siblings of affected children have about a 35 percent chance of also having reflux. Therefore in many cases, it is recommended that siblings of affected children are screened for VUR.
 
Reflux can lead to serious health issues. It can expose the kidneys to infection, pyelonephritis and can lead to scarring of the kidneys. Research has shown that renal scarring can cause long-term problems including impaired growth of the kidneys, hypertension and complications during pregnancy as an adult. The risk of developing renal scarring after an infection appears to be greatest during the first five to six years of life. Reflux can also contribute to urinary incontinence or frequency.
 
Grading VUR
 
Reflux is graded on a scale of 1 - 5 (1 least severe, 5 most severe).
  • Approximately 80 percent of children with Grade 1 or 2 will outgrow their reflux within five years
  • Approximately 50 percent of children with Grade 3 will also outgrow the condition within five years
  • As few as 10 percent of children with Grade 5 reflux will outgrow it
How is VUR diagnosed?
 
The diagnosis of reflux is made by performing a test called Voiding Cystourethrogram, or VCUG (also see the Child Life Teaching Sheet for VCUG). This involves placing a small catheter into the child's urethra and taking X-rays of the bladder using a contrast "dye" while filling and during urination. The child needs to be awake to tell when the bladder feels full. The child also needs to be able to urinate during the test. Parents are encouraged to stay close to their child during the test for comfort. Children with reflux will also have routine ultrasounds of the kidneys and bladder to assess for renal growth and presence of hydronephrosis, or dilation of the kidney.
 
VUR Treatment

Most children will outgrow bladder reflux. The plan of treatment depends on the child's age, presence of urinary tract infections and grade of reflux. To prevent infections which can contribute to scarring it is common to prescribe a daily prophylactic antibiotic. It is also typical to perform a VCUG and renal bladder ultrasound every 12 to 18 months until the reflux has resolved or surgery is indicated.