What is Vesicoureteral Reflux (VUR) in Children?

Vesicoureteral reflux (VUR) occurs when pee flows backward from the bladder to the kidneys. In most children, it is not serious, and they outgrow it with no lasting problems. Urine usually only travels from the kidneys to the bladder.

What are the types of vesicoureteral reflux?

The type involving one ureter and one kidney is called unilateral reflux. In a bilateral reflux condition, the ureters and the kidneys are involved. There are two types of VUR:

Primary VUR: The vast majorities of VUR cases are primary and involve unilateral reflux, which involves one ureter and one kidney. In the case of primary VUR, your child was born with a ureter that didn't connect into the bladder correctly. The flap valve between the ureter and the bladder wall doesn't close right, allowing pee to reflux from their bladder back into the ureter and sometimes to their kidney.
Secondary VUR: A blockage in the urinary canal that raises pressure and forces urine back up from the urethra into your child's bladder, ureters, or kidneys is the cause of secondary VUR. Pee may not be able to exit your child's bladder freely because of an aberrant fold of tissue in the urethra. A nerve condition that inhibits the bladder's ability to be triggered to flush could be another cause of secondary VUR. Children with secondary VUR typically have bilateral reflux, which impacts both kidneys and both ureters.

What are the symptoms of vesicoureteral reflux?

The majority of kids with VUR don't exhibit any symptoms. Doctors often discover the issue when a child has a fever and a urinary tract infection (UTI).

Lower urinary tract infections (UTIs) in the bladder can result in:

Peeing a lot or feeling a strong need to pee
Bedwetting and daytime pee accidents
Burning sensation when urinating
Urine that has blood in it, seems hazy, or has an unpleasant odor

The following symptoms can also be caused by a UTI that is higher in the urinary tract (in the kidneys or ureters):

Pain in the side, back, or belly
Fever and chills

What causes vesicoureteral reflux (VUR)?

Primary and secondary types of VUR have two distinct causes.

Primary VUR: The main cause of primary VUR in children is an anomaly with the flap valve connecting the ureter to their bladder. The valve has not closed properly, making pee back up toward his or her kidney instead of flowing downward. As he or she grows, this matures the organs and other structures, and the valve may close correctly, improving primary VUR.
Secondary VUR: The most frequent cause of secondary VUR is tissue obstruction or narrowing in the urethra or bladder neck. These problems cause pee to back into the urinary tract instead of exiting through the urethra. Your child may also have nerves to the bladder that don't work as well as they should. The concern is that this may mean that your bladder cannot normally contract or relax, thus resulting in an inability to pee from its usual output. Secondary VUR is much more common to occur as bilateral VUR.

At other times, doctors even diagnose the condition before birth. This could be in a routine prenatal ultrasound when it might be determined that the baby has hydronephrosis/urinary tract dilation, or swelling of the kidneys and the ureter (the tube that drains the kidneys into the bladder).

If your child has symptoms of a UTI, bring him or her to your doctor right away. Your doctor will ask about medical histories from both parents and may order tests. Some of these tests include:

Blood and urine tests check for kidney status and signs of infection or kidney damage.
An abdominal ultrasound uses sound waves to produce images of the urinary tract. These might demonstrate evidence of infection, kidney swelling, or thickening of the bladder.
A VCUG is a procedure explicitly done to evaluate for VUR. This test is done during the urination process. A technician instills the bladder with a special liquid and takes X-rays during urine filling and voiding.
Contrast-enhanced voiding urosonography (ceVUS). Similar to VCUG, a catheter is inserted and the bladder filled up with a contrast solution; but instead of taking pictures through X-ray, a specific type of ultrasound does that for it. The diagnostic is radiation-free.
The doctor will assign a grade ranging from I to V if the child has VUR. Pee merely backs up as far as the ureters in grade I reflux, which is the mildest type. The most severe type of reflux is grade V.

How Is Vesicoureteral Reflux Treated?

Children with mild VUR usually are not treated. Most children with primary VUR have spontaneous resolution, such that by the time the child grows and the ureter becomes longer and straighter, it will develop in an appropriate manner.

Doctors treat VUR that occurs with a UTI using antibiotics. This prevents the infection from moving into the kidneys. Children on antibiotics should complete the course as directed, even if they start to feel better. Some children will take antibiotics daily to prevent UTIs.

Surgery

The doctor may discuss surgery that can benefit children who have primary VUR. The most common type of surgery for ureteral reimplantation involves a surgical procedure that causes one or both of the ureters to extend further into the bladder. Because of the surgery, pee no longer flows backward from the bladder to the ureters and kidneys. Hospital stay will be about 1-2 days. During those days, the kid gets to recuperate. This surgery is done through an opening within the region that is below the underwear line or robotically with small incisions on the abdomen.

Another procedure is endoscopic injection, which involves injecting a special gel into the bladder via a thin tube. The surgeon places the gel into the opening of the ureter. This stops pee from flowing back into the ureter and allows the ureter to close correctly. Most children who have this procedure can go home from the hospital on the same day.

Children with secondary VUR are typically placed on antibiotics to help manage infections and treatment of the primary disease that caused VUR.

What are the risk factors for this disease?

The risk factors of VUR are:

Genetics: VUR appears to be a tendency in biological families. The risk of sibling VUR in one child is a little over 1 in 4. In the event that the parent had the condition of VUR, it is observed that the same is also seen in about 1 in 3 children.
Birth disorders: Children who are born with irregular kidneys or urinary tracts have a higher risk of developing VUR.
BBD (bladder and bowel dysfunction): Children with BBD fail to have regular bowel movements or urination. In some children, it occurs by weakness of muscles and nerve tissues.
Race and sex: According to studies, in a white child who assigned at birth as female tends to have VUR.

What are the complications of vesicoureateral reflux (VUR)?

Complications of VUR in children are as follows:

Urinary tract infections, such as bladder and kidney infections.
High blood pressure.
Kidney scarring, kidney damage (nephrotic syndrome), chronic kidney failure (rarely).
Most children with VUR recover without long-term complications.

Can VUR be prevented?

Vesicoureteral reflux (VUR) cannot be prevented by diet, lifestyle modifications, or medication. However, there are actions you may take to enhance the general health of your child's urinary system. Ensure that your child:

Hydrates well.
Changes their diaper right away after urinating and feces.
Does not retain urine and allows it to flow regularly.
Lets the pee flow regularly and does not hold it.
Treat your child promptly for constipation and urinary or fecal incontinence.
Help your child adopt a lifestyle by exercising with him or her and by providing balanced nutritious meals.

What can I expect if my child has vesicoureteral reflux (VUR)?

If your child is diagnosed with VUR, then work with your healthcare team on a treatment plan that fits your family's needs. A condition such as VUR can impact you and other caregivers in its management. Be sure to address your concerns with your child's healthcare team. Fortunately, VUR is a very treatable condition and most children do not experience long-term effects from the condition.

How often should I consult my doctor regarding vesicoureteral reflux?

You should see your pediatrician if you suspect your child has a UTI. Other common symptoms of VUR may be urinary incontinence and unexplained fever or painful urination. Your pediatrician will refer you to a specialist if they suspect VUR.

Why Choose Tender Palm Super Speciality Hospital for vesicoureteral reflux treatment in children in Lucknow, India?

Tender Palm Super-Speciality Hospital has the most trusted team of Pediatric Urologists with advanced diagnostic equipment and child-friendly care for Pediatric Vesicoureteral Reflux (VUR) treatment in Lucknow, India. Our Pediatric Urology department follows international safety standards and has years of experience in successfully managing children's Urological diseases.