Vesico-ureteric reflux (VUR) occurs when the valve between the ureters (the tubes that carry urine away from the kidneys) and the bladder is not working properly. Urine can flow backwards into the ureters, sometimes as far as the kidneys. If infected urine flows into the kidneys, this can damage them.
VUR occurs in about one in every 100 children. It is more common in girls than in boys.
If one child in a family has VUR, there is a chance that the other children could have VUR too, so brothers and sisters might be monitored. VUR is usually diagnosed in under fives.
It is much less common in older children, who may have outgrown the problem.
In many children, the tunnel through the bladder wall is not long enough, so the valve does not work properly, but this can improve as the child grows.
In some children, the ureters enter the bladder in a higher position than normal, which also means that the valve does not work properly. This is less likely to improve as the child grows.
Other children, particularly boys, may have a blockage in the urethra (posterior urethral valves) causing VUR.
Sometimes VUR can be diagnosed before birth when an ultrasound scan shows that one or both of a baby's kidneys look swollen and larger than usual (hydronephrosis).
When VUR is diagnosed after birth, it is usually suspected if a child has repeated urine infections.
Symptoms of a urine infection can include:
If a child has VUR, urine infections can damage the kidneys, as the urine flowing backwards towards them contains bacteria. Kidney damage can cause high blood pressure in later life or if untreated, may lead to kidney failure.
VUR is diagnosed and monitored using two particular scans:
The MCUG test is also used to 'grade' the degree of reflux, according to its severity. Grade 1 is the least severe form of VUR, where urine is flowing back up the ureters but is not reaching the kidneys. Grade 5 is the most severe, where a great deal of urine is reaching the kidneys, making the ureter and kidney swollen.
VUR is also described as 'unilateral' or 'bilateral' depending on whether one kidney (unilateral) is affected or both (bilateral).
At Children's Urology Hospital, we aim to treat VUR using medicines at first. Usually, a low dose of antibiotics is given on a long-term basis, often until the child is two to three years old.
This prevents urinary tract infections, which in turn, prevents any damage to the kidney caused by infected urine flowing backwards into them. Treatment with antibiotics gives many children the opportunity to outgrow VUR.
Children with VUR who are taking antibiotics will sometimes need to give regular urine samples, to be checked for any urine infections, particularly at an early stage. Ultrasound scans are often used to check that the kidneys are growing properly.
Children who continue to have urinary tract infections despite the antibiotics, or still have severe reflux after the age of five years old, might need an operation.
There are two types of procedure:
Avoiding urine infections is very important in vesico-ureteric reflux. You should encourage the child to:
For some boys, a circumcision (where the foreskin of the penis is removed) can help reduce infections.
If the correction is done by Deflux Injection, success is around 70%. Success by open surgery is nearly 97-98%.