Paediatric Urology – Vesico-ureteric reflux in children

V esico-ureteric reflux (VUR) is the abnormal flow of urine from the bladder back into the kidneys.

Backward flow of urine allows bacteria, which may be present in the bladder, to reach the kidney. This can lead to kidney infection – repeated episodes of kidney infection can cause kidney damage. Kidney infections are characterized by fever, chills and pain on the side of the abdomen.

1What causes vesico-ureteric reflux?

There are two general causes of VUR:

  • Congenital VUR: A baby may be born with an abnormality of the valve mechanism that prevents urine from flowing backwards from the bladder to the kidney. Most children with VUR have this problem and are born with it.
  • Acquired VUR: This occurs when there is some sort of blockage of the bladder outlet or the urethra (bladder pipe). This will causes an increase in the pressure inside the bladder, forcing urine back into the kidneys. In these cases the valve mechanism is normal, but the pressure is too high and overcomes the ability of the valve to keep the urine from flowing backwards into the kidney.
2What are the symptoms of vesico-ureteric reflux?

Although VUR itself usually does not cause any symptoms, it does cause bladder- and kidney infections. The symptoms of urinary tract infection (UTI) in children includes fever, burning urination, foul smelling urine and frequent urination. Small babies with a UTI may only have unexplained fever.

3What tests can be done for vesico-ureteric reflux?

  • Urine analysis to check for blood in the urine and for UTI.
  • Ultrasound to assess the bladder and the kidneys for abnormalities.
  • Urinating cystogram is a special X-ray test which uses a dye to detect urine backflow into the kidney.
  • Nuclear scan involves the use of a special radioactive dye to assess the function of each kidney and to detect scars caused by VUR and repeated infections.

4What are the complications of VUR?

  • Urinary tract infections.
  • Kidney damage leading to kidney failure.
  • High blood pressure (hypertension) requiring treatment with blood pressure medication.

5How is VUR treated?

Medical treatment:

Most children with VUR outgrow the problem by the age of 5 – 7 years. They can be offered supportive medical treatment to protect the kidneys and minimize infections, until the problem is outgrown. These supportive treatments may include:
  • Antibiotics to treat episodes of infection.
  • In young children who have frequent recurrence of UTI’s, antibiotics are given daily for months to years in order to prevent new infections.
  • Follow up with periodic X-ray or ultrasound to assess for the resolution of the VUR.


Although most children with VUR do not need surgery, it may be required in the following cases:
  • If your child gets repeated urinary tract infections despite antibiotic treatment.
  • Very severe forms of reflux that the child is unlikely to outgrow.
  • Persistent reflux in young women who plan to get pregnant. The aim of surgery would be to avoid UTI during pregnancy, which may be very dangerous to the mother and unborn baby.
  • Reflux associated with other serious abnormalities in the bladder.

The two common methods of surgical treatment of VUR include:

  • Endoscopic treatment:
    Involves injection of a special material inside the bladder to assist the valve mechanism and prevent backflow of urine to the kidneys. This entire procedure is performed using special cameras and very tiny instruments – not surgical incisions are required.
  • Open surgery:
    Involves modifying of the valve mechanism in order to make it more effective in preventing backflow of urine into the kidney.