Vesicoureteric reflux (VUR)

In normal kidney-bladder function, urine flows from the kidneys to the bladder. In children with vesicoureteral reflux (VUR), the urine flows backwards from the bladder up toward the kidneys. As a result, children with VUR are at risk for kidney infections and may develop kidney damage.

Facts about VUR:

• VUR affects about 1 percent of children.
• Many children will grow out of their VUR.
• Urine is normally sterile. When bacteria get into the bladder, a urinary tract infection, or (UTI) may result. In children with VUR, those bacteria can get to the kidneys more easily, resulting in a kidney infection.
• A kidney infection can be a serious illness, with high fever, nausea, vomiting or pain. Kidney infections can also lead to damage (scarring) of the kidney.
• To prevent infections in children with VUR, most children take low-dose antibiotics once a day to keep their urine sterile.
• The goal of treatment in children with VUR is to prevent kidney infections and kidney damage.
• Some children with VUR need surgery to correct the condition, prevent infection and protect the kidneys.

Indications for surgical treatment include the following:

• Breakthrough febrile UTIs despite adequate antibiotic prophylaxis
• Severe reflux (grade V or bilateral grade IV) that is unlikely to spontaneously resolve, especially if renal scarring is present
• Mild or moderate reflux in females that persists as the patient approaches puberty, despite several years of observation
• Poor compliance with medications or surveillance programs
• Poor renal growth or function or appearance of new scars

Virtually all open antireflux operations involve reconstruction of the ureterovesical junction to create a lengthened submucosal tunnel for the ureter, which functions as a one-way valve as the bladder fills. Dozens of procedures have been described. Options include open antireflux surgery via an extravesical or an intravesical approach and endoscopic antireflux surgery.