Kidneys are important organ for urine formation. Normally, urine flows into the bladder through ureters. However, in some children, urine from the bladder flows back through the ureters. This condition is known as Vesicouretral reflux (VUR) and is common in infants and children. It can be unilateral or bilateral. This could cause infections and damage your kidneys. VUR affects about 10% of children. Although most can grow out of this condition, people who have severe cases may need surgery to protect their kidneys. This condition should not be ignored as it damages the function of kidneys and can lead to high blood pressure later in life. The risk of kidney damage is greatest during the first 6 years of life.

1. Vesicoureteral Reflux Causes,
Symptoms And
Treatments by Dr. Prashant Jain
Vesicoureteral Reflux Causes, Symptoms And
Treatments
Kidneys are important organ for urine formation. Normally, urine flows into
the bladder through ureters. tfowever, in some children, urine from the
bladder flows back through the ureters. This condition is known
as Vesicouretral reflux (VUR) and is common in infants and children. It can
be unilateral or bilateral. This could cause infections and damage your
kidneys. VUR affects about 10% of children. Although most can grow out of
this condition, people who have severe cases may need surgery to protect
their kidneys.
This condition should not be ignored as it damages the function of kidneys and
can lead to high blood pressure later in life. The risk of kidney damage is
greatest during the first 6 years of life.
Causes of VUR:
A flap valve is located where the ureter joins with the bladder. Usually, the
valve allows only a one-way flow of urine from the ureters to the bladder.
Sometımes, a defective flap valve allows urine to flow backward. This can
affect one or both ureters. This is called “primary vesicoureteral reflux.”

2. Sometimes VUR can be because of blockage at the bladder outlet(Posterior
urethral valve or abnormality of the bladder functions (Neurogenic bladder)
that can causes urine to push back into the ureters.
This back flow of urine is responsible for recurrent urinary tract infections
and damage of kidney (Renal scarring).
Symptoms:
Urinary tract infection is one of the commonest presentation seen in children
younger than the age of 5.
Common symptoms are:
 Foul smelling or cloudy urine
 Fever
 Burning or pain while urinating
 Frequency and urgency of urine
 Vomiting
Infants may have following symptoms.
 Diarrhoea.
 Poor feeding.
 Fever

3.  Increased irritability
Also ultrasound scan done during pregnancy showing swelling in kidneys can
be because of VUR.
Diagnosis Of VUR:
VUR can often be suspected by ultrasound before a child is born or if child has
urinary tract infection. Ultrasound may show dilatation of drainage system of
kidney (Pelvi-calyceal system and ureter) called as hydronephrosis, but this
does not prove that reflux is present.
VUR is diagnosed using an X-ray of the bladder known as voiding
cystourethrogram (VCUG). In this procedure, a thin, soft tube (catheter) is
placed in the bladder through the urethra. Dye is then introduced into the
bladder through the tube. X-ray pictures are taken to seeif the dye flows back
into the ureters. Based upon the severity, VUR is categorized into five grades.
Milder grade of VUR does not require any treatment. All infants with urinary
tract infection and other older children with frequent urinary tract infections
with or without hydronephrosis should a be considered for VCUG test.
Treatment Options For Management Of VUR:
There are 3 main options for managing or treating VUR. One should
understand the risks, benefits, and follow-up of each treatment.
Antibiotic: It is used to prevent infections until VUR goes away by itself. This
treatment may take several years, and children must take medication every
day. These children need to be reassessed for VUR and renal damage on
regular basis. tfowever, long term treatment with antibiotics may cause the
bacteria to become resistant, increasing the risks of recurrent infections.

4. Surgery: This type of treatment cures most children. Surgery is good option
for high grade reflux. This can be performed by open or laparoscopic
technique.
Endoscopic treatment (Deflux Injection): In this day care procedure, the
medication is injected where the ureter joins the bladder. Deflux is a safe and
effective treatment for VUR. A gel is introduced into the body where the
ureters meet the bladder. This procedure is performed as a day care
procedure. Deflux gel is placed at the spot where the ureters connect to the
bladder with the help of a small camera called a cystoscope (a type of
endoscope used to view the bladder). Eventually, new tissue grows around the
gel, preventing the reflux of urine. Usually, there will be no pain after the
procedure. Deflux is used for the treatment of all grades of VUR in children.
Many children have success after one injection; while some may need more
injection procedures. tfowever lower the grade of VUR, the better it works.
Also, the procedure works better for children who have reflux in only one
ureter.