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Vesicoureteral reflux (VUR) is the flow backwards of the urine from the bladder back up into the kidneys. The normal flow of urine is from the kidneys, along the ureters to the bladder. Normally the muscles of the bladder and ureters, and the pressure of urine in the bladder, prevent urine from backward flow through the ureters.

Incidence : VUR about 1 in every 100 children.

What causes vesico-ureteric reflux?
In many children, the the valve does not work properly, but this can improve as the child grows.
Other children, particularly boys, may have a blockage in the urethra (see posterior urethral valves) causing VUR.

What are the signs and symptoms of vesico-ureteric reflux?
Sometimes VUR can be diagnosed before birth with scan (ultrasound). This may show that one or both of a baby’s kidneys look swollen and larger than usual known as hydronephrosis.

When VUR is diagnosed after birth, it is usually suspected if a child has repeated urine infections.

Symptoms of a urine infection can include:
burning sensation during urination
urinating more often than usual
abdominal pain
a high temperature
reduced appetite or foul smelling urine
VUR is also described as ‘unilateral’ (one side) or ‘bilateral’ (both kidneys) depending on whether one kidney (unilateral) is affected or both (bilateral).

How is vesico-ureteric reflux normally treated?
Usually treat VUR using medicines at first. Usually, a low dose of antibiotics is given on a long-term basis, often until the child is two to three years old.

This prevents urinary tract infections, which in turn, prevents any damage to the kidney caused by infected urine flowing backwards into them. Treatment with antibiotics gives many children the opportunity to outgrow VUR.

Children with VUR who are taking antibiotics will sometimes need to give regular urine samples, to be checked for any urine infections, particularly at an early stage. Ultrasound scans are often used to check that the kidneys are growing properly.

Can vesico-ureteric reflux be prevented?
Avoiding urine infections is very important in vesico-ureteric reflux. You should encourage the child to:
drink plenty of fluids
go to the toilet regularly (every three to four hours)
eat plenty of wholegrain cereals, bread, fruit and vegetables to avoid constipation
For some boys, a circumcision for vesico ureteric reflux can help reduce infections.