Vesicoureteral Reflux (VUR)

Vesicoureteral Reflux (VUR)

Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into one or both ureters and sometimes up to the kidneys. It’s most common in infants and young children, and a major risk factor for recurrent urinary tract infections (UTIs) and kidney damage.

📌 Normal vs. Reflux Mechanism

• Normally, the ureter enters the bladder at an angle, forming a flap-valve that closes during bladder filling and voiding.
• In VUR, this valve mechanism is defective, allowing retrograde flow of urine.

🧬 Types of VUR

1. Primary VUR (most common)

• Congenital defect in the UVJ (ureterovesical junction).
• Often familial (genetic predisposition).

2. Secondary VUR

• Caused by bladder outlet obstruction or high bladder pressure.
• Seen in:
  • Posterior urethral valves (boys)
  • Neurogenic bladder
  • Chronic constipation

🎯 Grading of VUR (I–V)

⚠️ Symptoms

• Recurrent febrile UTIs (most common presentation)
• Enuresis (bedwetting)
• Flank or abdominal pain
• Failure to thrive (in infants)
• Hypertension or signs of chronic kidney disease (in severe or long-standing cases)

🧪 Diagnosis

1. Voiding Cystourethrogram (VCUG)

• Gold standard test
• Involves filling the bladder with contrast and watching for reflux during urination

2. Renal Ultrasound

• Looks for hydronephrosis, scarring, or asymmetry

3. DMSA Scan (nuclear medicine)

• Assesses kidney scarring and differential function

4. Urinalysis and Culture

• Recurrent UTIs are the main clue

🩺 Treatment

Depends on:

• Age
• Severity (grade of VUR)
• Frequency of UTIs
• Kidney function and scarring

Non-Surgical (Conservative) Management

• Often used in low-grade (I–III) reflux
• Prophylactic antibiotics to prevent UTIs (e.g., low-dose TMP-SMX or nitrofurantoin)
• Watchful waiting with regular imaging
• High rates of spontaneous resolution, especially in young children

Surgical or Procedural Treatment

• Indicated for:
  • High-grade reflux (IV–V)
  • Recurrent febrile UTIs despite prophylaxis
  • Renal scarring or deterioration
  • Non-resolution over time

Options:

1. Endoscopic injection (Deflux®)
   • Gel injected into UVJ to improve valve function
   • Minimally invasive, outpatient
2. Ureteral reimplantation surgery
   • Reconstructs UVJ to prevent reflux
   • Very effective but more invasive

🔄 Prognosis

• Excellent in most children, especially with early detection and proper management.
• Long-term follow-up needed to monitor for:
  • Renal scarring
  • Blood pressure issues
  • Renal growth