Vesicoureteral (ves-ih-koe-yoo-REE-ter-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 only down from your kidneys to your bladder.
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.
Vesicoureteral reflux can be primary or secondary. 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. Secondary vesicoureteral reflux is due to a urinary tract malfunction, often caused by infection.
Children may outgrow primary vesicoureteral reflux. Treatment, which includes medication or surgery, aims at preventing kidney damage.
A urinary tract infection (UTI) is the most common indication of vesicoureteral reflux. A 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 other signs and symptoms, including:
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.
When to see a doctor
Call your doctor about fever if your child:
In addition, call your doctor immediately if your infant has the following signs or symptoms:
Your urinary system includes your kidneys, ureters, bladder and urethra. All play a role in removing waste products from your body.
The kidneys, a pair of bean-shaped organs at the back of your upper abdomen, filter waste, water and electrolytes — minerals, such as sodium, calcium and potassium, that help maintain the balance of fluids in your body — from your blood. 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 forms, primary and secondary:
Female urinary system
Your bladder stores urine produced by your kidneys and expels it through a tube called the urethra. In women, the urethral opening is above the vagina. ...
Male urinary system
Your bladder stores urine produced by your kidneys and expels it through a tube called the urethra. In men, the urethral opening is at the tip of the penis. ...
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:
Preparing for your appointment
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.
Seek immediate care for an infant who:
After evaluation, your child may be referred to a doctor who specializes in urinary tract conditions (urologist).
Here's some information to help you get ready, and what to expect from your child's doctor.
What you can do
For vesicoureteral reflux, some basic questions to ask your child's doctor include:
Don't hesitate to ask 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 is not clear-cut. In order to arrive at a treatment decision 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.
What to expect from your doctor
Tests and diagnosis
Laboratory analysis of urine (urinalysis) can reveal whether your child has a UTI. Other tests are necessary to determine the presence of vesicoureteral reflux. They may include:
Grading the condition
Treatments and drugs
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 will likely recommend a wait-and-see approach. During this time, it will be important for you to be watchful for potential UTIs and to seek prompt treatment.
Children with moderate to severe primary vesicoureteral reflux have two treatment options: medication and surgery. Using medication is more common, with surgery usually reserved for those children for whom antibiotics aren't successful.
However, surgery may be a first line therapy for grades IV and V or for families who prefer a quicker, more definitive treatment than medication.
Commonly used antibiotics for prevention include the combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra), trimethoprim (Primsol) and nitrofurantoin (Furadantin, Macrobid, Macrodantin). Some people may be allergic to one or more of these medications, preventing their use. Possible side effects of long-term use of these drugs include:
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.
Lifestyle and home remedies
UTIs, 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:
Last Updated: 2011-07-16
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