Vesicoureteral Reflux

Overview

Vesicoureteral Reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and sometimes back into the kidneys. This can lead to urinary tract infections (UTIs) and kidney damage. VUR is more common in infants and young children and can be classified as primary or secondary.

The condition was first classified in the 20th century, with significant advancements in understanding the anatomy and physiology of the urinary tract in pediatric patients. Over time, diagnostic methodologies such as voiding cystourethrogram (VCUG) and renal ultrasound have greatly enhanced the ability to identify VUR. Treatment modalities have evolved from open surgical interventions to more minimally invasive techniques and pharmacological management. The condition can run in families and is sometimes associated with other congenital syndromes.

Causes

Primary VUR: Congenital defect in the valve mechanism at the junction of the bladder and ureter, often identified in infants and young children.

Secondary VUR: Elevated bladder pressures, bladder outlet obstruction, voiding dysfunction, and/or prior urinary tract surgery.

Risk Factors

• Family history of VUR or urinary tract abnormalities.
• Caucasian race.
• Female gender (more likely to have VUR).
• Previous UTI or bladder dysfunction.

Complications

The primary effect of VUR is the increased risk of urinary tract infections (UTIs), which can ascend from the bladder to the kidneys, leading to pyelonephritis and renal scarring. This scarring, in turn, has the potential to cause hypertension and impaired renal function over time. VUR can also contribute to urinary incontinence in some patients.

Recurrent UTIs, which can lead to kidney infections (pyelonephritis).

Kidney scarring and potential kidney damage.

Hypertension (high blood pressure).

Decreased kidney function or chronic kidney disease.

Urinary incontinence due to “yo-yo” voiding

Prevention

• Early diagnosis and treatment of UTIs to prevent kidney damage.
• Regular monitoring for children with a family history of VUR.
• Adequate hydration and regular urination to prevent bacteria.