Vesicoureteral reflux (VUR)

We understand that you may have a lot of questions when your child is diagnosed with vesicoureteral reflux, such as: Is it dangerous? Will it affect my child long term? What do we do next? We’ve tried to provide some answers to those questions in the following pages, and our experts can explain your child’s condition fully.

Causes

What causes vesicoureteral reflux?

VUR is the result of abnormal formation of the normal valve between the kidney and bladder. This valve is supposed to ensure that urine only goes one way, from the kidney to the bladder. In children with VUR this valve does not work correctly. The cause of this abnormality is not known. However, many children with VUR have certain characteristics incommon:

• VUR is common among children and siblings of people with VUR. There is a strong genetic component to VUR, although no specific genes have been identified.
• Children with abnormal bladder function due to nerve or spinal cord problems, such as spina bifida, may have VUR.
• VUR can occur in children with other urinary tract abnormalities such as posterior urethral valves, bladder exstrophy, ureterocele or ureter duplication.
• Children with dysfunctional voiding (bladder and bowel problems, including accidents, frequent urination or constipation) may be more likely to have VUR.
• During infancy, the disease is more commonly seen in boys. In older children, VUR is more commonly diagnosed in girls.
• VUR is more common in Caucasian children than in African-American children.

Symptoms

What are the symptoms of vesicoureteral reflux?

Children who have VUR may not feel sick, and VUR itself usually has no symptoms. VUR is most often diagnosed after a child has a urinary tract infection (UTI). Some children are also diagnosed shortly after birth if they had hydronephrosis (fluid on the kidneys) seen on their prenatal (before birth) ultrasounds. Common symptoms of UTI in children include:

• fever
• pain or burning with urination
• strong or foul odor to the urine
• sudden onset of frequent urination or wetting accidents
• abdominal or flank pain

FAQ

Q: Can vesicoureteral reflux (VUR) be prevented?
A: No. However, the urinary tract infections that are often associated with VUR can be prevented, with changes to toileting behaviors, management of constipation and preventive antibiotics.

Q: Is VUR inherited?
A: Yes, VUR is more common in family members of people with VUR. For this reason, you should discuss with your doctor whether siblings or other family members should be tested for VUR.

Q: Is surgery mandatory?
A: Many children with VUR will outgrow their VUR on their own. Therefore, we do not perform surgery as initial treatment in most children. However, some children will require surgery to correct VUR eventually. The most common reasons for surgical correction of VUR are repeated UTI with kidney involvement, failure of VUR to resolve on its own over time, or severe VUR that is very unlikely to resolve.

Q: Are antibiotics safe to take for long time?
A: Yes. The preventive antibiotics used are given once-a-day and are very low dose. There are some risks associated with any medication, but we believe that the benefits of preventing UTI (and kidney scarring) in children with VUR outweigh any small risks from taking the antibiotics for long periods. We have treated thousands of children with preventive antibiotics for many years with very few severe side effects.

Q: Don’t children become “immune” to the antibiotics?
A: Children do not become immune to antibiotics. Their immune systems (the germ-fighting and infection-fighting systems) remain fully functional and aren’t altered by being on these medications. The children can still fight off infections normally. However, the bacteria (germs) that live on and inside of human beings can become resistant to certain antibiotics through chronic exposure. Since most UTIs are caused by the germs that live on us, this can be a problem.

This problem is minimized by properly selecting the best antibiotic medicines for UTI prevention, using a very low dose, and giving it only once a day. Resistance to antibiotics is a major concern in healthcare and is being studied carefully.

Q: What is the RIVUR study?
A: This is a large research study funded by the National Institutes of Health. The Urology Department at Boston Children's Hospital is participating in the RIVUR study. The purpose of this study is to determine if preventive antibiotics are effective in preventing urinary tract infections in children with VUR. For more information about RIVUR, you can visit the study web page.

Q: If my child has VUR, what type of follow-up is needed?
A: Children with VUR are usually followed until their reflux goes away or is surgically corrected. Most children are seen every six to 12 months. Your doctor will often use ultrasound to follow your child’s kidney growth and health. We perform special tests to check for VUR every one to two years. Although VUR may resolve, in some cases, VUR can result in scarring in the kidney, which can lead to high blood pressure. Children with scars in their kidneys should have their blood pressure and urine checked every six months, even if their VUR has gone away.