Learn about what happens if urine flows backward from the bladder. Usually found in children, this condition boosts the risk of urinary tract infections.
Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux is the abnormal flow of urine from your bladder back up the tubes (ureters) that connect your kidneys to your bladder. Normally, urine flows from your kidneys through the ureters down to your bladder. It's not supposed to flow back up.
Vesicoureteral reflux is usually diagnosed in infants and children. The disorder increases the risk of urinary tract infections, which, if left untreated, can lead to kidney damage.
Children may outgrow primary vesicoureteral reflux. Treatment, which includes medication or surgery, aims at preventing kidney damage.
Your urinary system includes the kidneys, ureters, bladder and urethra. The urinary system removes waste from the body through urine. The kidneys are located toward the back of the upper abdomen. They filter waste and fluid from the blood and produce urine. Urine moves from the kidneys through narrow tubes to the bladder. These tubes are called the ureters. The bladder stores urine until it's time to urinate. Urine leaves the body through another small tube called the urethra.
Urinary tract infections commonly occur in people with vesicoureteral reflux. A urinary tract infection (UTI) doesn't always cause noticeable signs and symptoms, though most people have some.
These signs and symptoms can include:
A UTI may be difficult to diagnose in children, who may have only nonspecific signs and symptoms. Signs and symptoms in infants with a UTI may also include:
As your child gets older, untreated vesicoureteral reflux can lead to:
Another indication of vesicoureteral reflux, which may be detected before birth by sonogram, is swelling of the kidneys or the urine-collecting structures of one or both kidneys (hydronephrosis) in the fetus, caused by the backup of urine into the kidneys.
Contact your doctor right away if your child develops any of the signs or symptoms of a UTI, such as:
Call your doctor about fever if your child:
Hydronephrosis occurs when a kidney has an excess of fluid due to a backup of urine, often caused by an obstruction in the upper part of the urinary tract. Kidney swelling can result, causing the part of the kidney called the renal pelvis to bulge (distend), leading to possible kidney scarring and impaired kidney function.
Your urinary system includes your kidneys, ureters, bladder and urethra. All play a role in removing waste products from your body via urine.
Tubes called ureters carry urine from your kidneys down to your bladder, where it is stored until it exits the body through another tube (the urethra) during urination.
Vesicoureteral reflux can develop in two types, primary and secondary:
Primary vesicoureteral reflux. Children with primary vesicoureteral reflux are born with a defect in the valve that normally prevents urine from flowing backward from the bladder into the ureters. Primary vesicoureteral reflux is the more common type.
As your child grows, the ureters lengthen and straighten, which may improve valve function and eventually correct the reflux. This type of vesicoureteral reflux tends to run in families, which indicates that it may be genetic, but the exact cause of the defect is unknown.
Risk factors for vesicoureteral reflux include:
Kidney damage is the primary concern with vesicoureteral reflux. The more severe the reflux, the more serious the complications are likely to be.
Complications may include:
A urine test can reveal whether your child has a UTI. Other tests may be necessary, including:
Specialized X-ray of urinary tract system. This test uses X-rays of the bladder when it's full and when it's emptying to detect abnormalities. A thin, flexible tube (catheter) is inserted through the urethra and into the bladder while your child lies on his or her back on an X-ray table. After contrast dye is injected into the bladder through the catheter, your child's bladder is X-rayed in various positions.
Then the catheter is removed so that your child can urinate, and more X-rays are taken of the bladder and urethra during urination to see whether the urinary tract is functioning correctly. Risks associated with this test include discomfort from the catheter or from having a full bladder and the possibility of a new urinary tract infection.
After testing, doctors grade the degree of reflux. In the mildest cases, urine backs up only to the ureter (grade I). The most severe cases involve severe kidney swelling (hydronephrosis) and twisting of the ureter (grade V).
Treatment options for vesicoureteral reflux depend on the severity of the condition. Children with mild cases of primary vesicoureteral reflux may eventually outgrow the disorder. In this case, your doctor may recommend a wait-and-see approach.
For more severe vesicoureteral reflux, treatment options include:
UTIs require prompt treatment with antibiotics to keep the infection from moving to the kidneys. To prevent UTIs, doctors may also prescribe antibiotics at a lower dose than for treating an infection.
A child being treated with medication needs to be monitored for as long as he or she is taking antibiotics. This includes periodic physical exams and urine tests to detect breakthrough infections — UTIs that occur despite the antibiotic treatment — and occasional radiographic scans of the bladder and kidneys to determine if your child has outgrown vesicoureteral reflux.
Surgery for vesicoureteral reflux repairs the defect in the valve between the bladder and each affected ureter. A defect in the valve keeps it from closing and preventing urine from flowing backward.
Methods of surgical repair include:
Robotic-assisted laparoscopic surgery. Similar to open surgery, this procedure involves repairing the valve between the ureter and the bladder, but it's performed using small incisions. Advantages include smaller incisions and possibly less bladder spasms than open surgery.
But, preliminary findings suggest that robotic-assisted laparoscopic surgery may not have as high of a success rate as open surgery. The procedure was also associated with a longer operating time, but a shorter hospital stay.
Endoscopic surgery. In this procedure, the doctor inserts a lighted tube (cystoscope) through the urethra to see inside your child's bladder, and then injects a bulking agent around the opening of the affected ureter to try to strengthen the valve's ability to close properly.
This method is minimally invasive compared with open surgery and presents fewer risks, though it may not be as effective. This procedure also requires general anesthesia, but generally can be performed as outpatient surgery.
Cystoscopy allows a health care provider to view the lower urinary tract to look for problems, such as a bladder stone. Surgical tools can be passed through the cystoscope to treat certain urinary tract conditions.
Urinary tract infections, which are so common to vesicoureteral reflux, can be painful. But you can take steps to ease your child's discomfort until antibiotics clear the infection. They include:
If bladder and bowel dysfunction (BBD) contributes to your child's vesicoureteral reflux, encourage healthy toileting habits. Avoiding constipation and emptying the bladder every two hours while awake may help.
Doctors usually discover vesicoureteral reflux as part of follow-up testing when an infant or young child is diagnosed with a urinary tract infection. If your child has signs and symptoms, such as pain or burning during urination or a persistent, unexplained fever, call your child's doctor.
After evaluation, your child may be referred to a doctor who specializes in urinary tract conditions (urologist) or a doctor who specializes in kidney conditions (nephrologist).
Here's some information to help you get ready, and what to expect from your child's doctor.
Before your appointment, take time to write down key information, including:
For vesicoureteral reflux, some basic questions to ask your child's doctor include:
Don't hesitate to ask additional questions that occur to you during your child's appointment. The best treatment option for vesicoureteral reflux — which can range from watchful waiting to surgery — often isn't clear-cut. To choose a treatment that feels right to you and your child, it's important that you understand your child's condition and the benefits and risks of each available therapy.
Your child's doctor will perform a physical examination of your child. He or she is likely to ask you a number of questions as well. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask: