Vesicoureteral Reflux (VUR)

What Is Vesicoureteral Reflux?

In this condition, urine, which should normally flow only from the kidneys through the ureters toward the bladder, flows back upward because the valve structure at the lower end where the ureter opens into the bladder does not work adequately.

How Common Is It?

It is a common congenital disorder, with a prevalence of 1%. In children with recurrent urinary tract infections, this rate is between 30% and 50%. It is found in 16% of children in whom kidney dilation (hydronephrosis) was detected on ultrasound before birth. The likelihood is 27% in children whose sibling has VUR, while the average frequency is 35% in children whose parent has VUR.

Diagnosis

The diagnosis is made during evaluations of children who have had a febrile urinary tract infection or in whom kidney swelling (hydronephrosis) was detected before birth.

Voiding cystourethrography (VCUG): This test, commonly known as a "catheter X-ray", is the most important and most informative test for diagnosis. Contrast material is given into the bladder through a catheter, and images taken at intervals assess whether there is backflow as the bladder fills and empties. If vesicoureteral reflux is present, it is graded from 1 to 5 according to its severity.

In children diagnosed with vesicoureteral reflux, tests such as urinary ultrasound, a kidney scan (DMSA) and urodynamic testing may be needed to assess the condition of the kidneys and bladder.

Why Is Vesicoureteral Reflux Important?

This condition is an anatomical and/or functional disorder that can lead to serious consequences such as kidney damage, hypertension and kidney failure.

In children who do not have urinary tract infections and whose bladder works properly, vesicoureteral reflux does not cause kidney damage. Therefore, the main aim of treatment is to preserve kidney function by taking measures that reduce the risk of kidney infection.

Treatment

Non-Surgical (Conservative) Treatment: The main aim is to prevent febrile urinary tract infections. Most children with low-grade vesicoureteral reflux improve on their own. In five-year follow-ups, reflux resolves spontaneously in 80% of those with grade 1 and 2 reflux and in 30-50% of those with grade 3-5 reflux.

Antibiotic prophylaxis: Long-term preventive use of antibiotics at doses lower than the therapeutic dose, to prevent the urine from becoming infected.

Voiding training: The child should go to the toilet every 2-3 hours at home and at school and urinate regularly. For the child's pelvic floor muscles to relax and the bladder and bowels to empty completely, the child needs to sit in a proper position on the toilet with feet flat on the floor, with a support placed under the feet if needed. Fluid intake should be spread evenly throughout the day. If there is constipation, it must be resolved.

In boys, early circumcision is part of the conservative approach because it protects against infection.

Surgical Treatment

Endoscopic injection of bulking agents (STING): A procedure in which a cystoscope is passed into the bladder and a bulking agent is injected at the ureteral opening. It is a short, same-day procedure, and its success rate rises to 85% with repeat injections.

Ureteral reimplantation surgery: Procedures that create a tunnel at the lower end of the ureter and, if necessary, reattach it to the bladder. Many surgical techniques have been described for this, with success rates of around 98%.