Vesicoureteral reflux occurs in approximately one in 100 children. The majority of children with the condition will not require any treatment and will grow out of the condition in childhood. However, a small number will require surgery to correct the condition.
General informationThe urinary tract is made up of the kidneys, the ureters, the bladder and the urethra. Urine produced by the kidneys flows to the bladder via the ureters. The bladder acts as a reservoir for the urine until it is excreted from the body via the urethra. At the junction where each ureter enters the bladder (the ureterovesical junction) there is a valve mechanism. As the bladder is being emptied these valves close, preventing urine from flowing backwards (refluxing) towards the kidneys.
Vesicoureteral reflux is graded 1 to 5, with 1 being the mildest and 5 being the most severe:
Signs and symptoms
Vesicoureteral reflux does not produce any symptoms. These occur when infection of the urinary tract (UTI) is present. Infection causes symptoms such as fever, pain, unpleasant smelling urine and a burning sensation when urinating. Other symptoms commonly experienced include:
- Bed-wetting (nocturnal enuresis)
- Lower abdominal pain
- Blood in the urine (haematuria) and/or pus in the urine (pyuria)
- High blood pressure
- Kidney failure.
Vesicoureteral reflux is most commonly first suspected in infancy with the occurrence of repeated urinary tract infections. Most children who experience UTIs have a normal urinary tract. However up to 30% of them have some degree of urinary reflux. Children who experience repeated UTIs should be investigated for vesicoureteral reflux. As the condition can run in families, there is a chance that a child’s siblings may also be affected by vesicoureteral reflux. It may be suggested that they are screened to rule this out. Common investigations used to diagnose vesicoureteral reflux and assess for kidney damage include:
The bladder and kidneys are scanned to survey the anatomy and assess for any irregularities.
Micturating Cystourethrogram (MCU):
A small tube (catheter) is put into the child’s bladder and a radio-opaque (visible on x-ray) liquid is passed into the bladder. X-rays are taken as the bladder fills and as the child urinates.
DSMA Renal Scan:
Pictures of the kidneys are taken with a specialised scanner following the injection of a weak radioactive solution (radioisotope) into the bloodstream via a drip in the hand or arm. The pictures taken by the scanner can assess kidney size, position and function and check for scarring of the kidneys as the result of repeated UTI’s.
UTIs require prompt treatment with antibiotics to prevent infection developing in the kidneys. In children who have recurrent UTIs, prophylactic (preventative) antibiotics may be recommended to prevent UTIs from developing, and hence prevent damage to the kidneys. Again, the health and growth of the kidneys will be regularly assessed with ultrasound scans.
Whilst surgery is no longer done routinely for vesicoureteral reflux, a small number of children will require surgery to correct the problem. This is particularly so for children with severe (grade 4 – 5) vesicoureteral reflux who have the following problems:
- They continue to develop UTI's while taking prophylactic antibiotics
- The child is allergic to the antibiotics
- The reflux does not resolve or worsens over time
- The kidneys are showing signs of damage.
Further information and support
Kidney Health New Zealand provides education and support about different kidney diseases. Their website provides details of patient support centres in New Zealand.
Kidney Health New Zealand
Mayo Clinic (2014). Vesicoureteral reflux (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/vesicoureteral-reflux/basics/definition/con-20031544 [Accessed: 22/09/17]
KidsHealth (2015). Urinary reflux (vesico-ureteric reflux) (Web Page). Auckland: Paediatric Society of New Zealand and Starship Foundation. https://www.kidshealth.org.nz/urinary-reflux [Accessed: 22/09/17]