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Vesicoureteral Reflux -- Adult

Definition

Vesicoureteral reflux (VUR) is the backward flow of urine. The urine flows from the bladder back into the kidney.

Urine normally flows from the kidneys. It passes through tubes called ureters. It then flows into the bladder. Each ureter connects to the bladder in a way that prevents urine from flowing back up the ureter. The connection is similar to a one-way valve. When this does not work properly, or if the ureters do not extend far enough into the bladder, urine may flow back up to the kidney. If the urine contains bacteria, the kidney may become infected. The back up can also put extra pressure on the kidney. This can cause kidney damage.

Anatomy of the Urinary System
The Urinary Tract
Copyright © Nucleus Medical Media, Inc.

Causes

This condition may be caused by:

Risk Factors

Factors that increase your chance of developing VUR include:

  • Family history
  • Congenital abnormalities of the urinary tract
  • Birth defects that affect the spinal cord, such as spina bifida
  • Tumors in the spinal cord or pelvis
  • Spinal cord injury

Symptoms

In most cases, VUR has no obvious symptoms or signs. In some cases, VUR is found after a urinary tract or kidney infection is diagnosed. Symptoms of urinary tract infections include:

  • Frequent and urgent need to urinate
  • Passing small amounts of urine
  • Pain in the abdomen or pelvic area
  • Burning sensation during urination
  • Cloudy, bad-smelling urine
  • Increased need to get up at night to urinate
  • Blood in the urine
  • Leaking urine
  • Low back pain or pain along the side of the ribs
  • Fever and chills

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Urine tests
  • Ultrasound

Images may be taken of your bodily structures. This can be done with:

  • CT scan
  • Voiding cystourethrogram (VCUG)
  • Intravenous pyelogram
  • Nuclear scans

Treatment

The goal for treatment of VUR is to prevent any permanent kidney damage. Treatment options include the following:

Surgery

Endoscopic Injection Into the Ureter

This procedure is a minimally invasive surgery. It is done to correct the reflux. A gel is injected where the ureter inserts into the bladder. This can prevent urine from going back up the ureter. This procedure is done through a small tube called a cystoscope.

Ureteral Reimplantation

This surgery repositions the ureters in the bladder. It can be done in two ways. One way requires making an incision above the pubic bone and repositioning the ureters in the bladder. It can also be done laparoscopically by inserting cameras through small incisions in the abdomen and/or bladder to perform the surgery.

Prevention

VUR cannot be prevented in most cases. However, further complications can be avoided. Seek prompt treatment for bladder or kidney infections. This is particularly important if you have a neurogenic bladder.

Revision Information

  • National Kidney Foundation

    http://www.kidney.org

  • Urology Care Foundation

    http://www.urologyhealth.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • The Kidney Foundation of Canada

    http://www.kidney.ca

  • Valla JS, Steyaert H, et al. Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: a single-centre 5-year experience. J Pediatr Urol. 2009;5(6):466-471.

  • Vesicoureteral reflux. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 15, 2013. Accessed July 16, 2013.

  • Vesicoureteral reflux. National Kidney and Urological Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/vesicoureteralreflux/. Updated June 29, 2012. Accessed July 16, 2013.

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