Vesicoureteral Reflux (VUD)
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Normally, urine flows out of the kidneys to the bladder through tubes called ureters. The muscles of the bladder and ureters, along with the urine pressure in a full bladder, should prevent urine from flowing backward from the bladder toward the kidneys. Vesicoureteral reflux, or VUR, is the backward flow of urine from the bladder into the kidneys, due either to a primary failure of the normal valve mechanism (primary reflux) or, less frequently, some other abnormality of the bladder (secondary reflux).
VUR carries bacteria present in the urine in the bladder to the kidneys. This can lead to infection, scarring and damage to the kidney. This backward flow can put pressure on the kidney, which also can contribute to kidney damage.
VUR is common – it occurs in about one in 100 children. It is more common among Caucasians. It is more common in children whose parents or siblings had reflux, though patients without any family history can also be affected.
VUR can occur either as primary VUR or secondary VUR. Primary VUR, the most common type, is a birth defect during the development of the valve at the bladder end of the ureter (the tube that carries urine from the kidneys to the bladder).
Secondary VUR occurs when abnormal pressures in the bladder, due to malfunction of the bladder or obstruction of the bladder or urethra, causes urine to flow backward into the kidneys. Causes of secondary VUR include surgery, injury or spinal defects. While primary reflux is present at birth, secondary reflux can happen at any age.
Most often, a child with VUR has no symptoms. These children are at little risk of harm from reflux.
The most common symptom associated with VUR is urinary tract infection, especially infections with fever. Children with urinary tract infections with fever or recurrent urinary tract infections or a family history of VUR should undergo a careful urologic history and physical exam to determine their risk for VUR.
Sometimes doctors suspect VUR before birth from a prenatal ultrasound. Most often, doctors discover it as they treat recurrent urinary tract infections or bladder infections associated with fever. The initial testing usually includes an ultrasound of the kidneys and bladder, and a voiding cystourethrogram (an X-ray of the bladder).
In treating VUR, doctors focus on preventing any permanent kidney damage. This requires careful follow up.
In milder cases of VUR, immediate treatment may be simple observation. VUR may resolve on its own as the child grows and the valve mechanism in the bladder matures. In other cases, doctors will prescribe antibiotics to prevent or treat infection and reduce the chance of kidney scarring while waiting for the VUR to resolve. In more severe cases, corrective surgery may be necessary. Surgery can be minimally invasive; the doctor might inject a gel to repair the malfunction of the valve in the bladder. Sometimes, more traditional surgery may be needed to treat the problem.
The outcome of patients with VUR depends upon the child's progress after diagnosis. This requires careful follow up often over several years. Overall, the treatment of reflux is very successful at preventing or minimizing kidney damage and limiting long-term consequences of the disease.
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