Vesicoureteral Reflux (VUR) is a pediatric urological condition where urine flows backward from the bladder into the ureters and sometimes up into the kidneys. This reverse flow can expose the kidneys to infection and long-term damage. In children, VUR is a major cause of recurrent urinary tract infections (UTIs) and renal scarring if not diagnosed and treated early.
With expert care from a skilled pediatric urologist in Nagpur like Dr. Sadashiv Bhole, VUR can be managed successfully through medication, monitoring, or surgery, depending on severity.
What is Vesicoureteral Reflux (VUR)?
In normal anatomy, the ureters carry urine from the kidneys to the bladder through a one-way valve. In children with VUR, this valve does not close properly, allowing urine to flow backward.
VUR is classified into five grades:
- Grade I: Urine refluxes into ureter only
- Grade II: Urine reaches the kidney but without dilation
- Grade III: Mild dilation of ureter and renal pelvis
- Grade IV: Moderate dilation with tortuosity
- Grade V: Severe dilation and damage to the kidney structure
Causes and Risk Factors
- Congenital defect in the ureterovesical junction (most common)
- Family history of VUR
- Posterior urethral valves (PUV) in boys
- Bladder dysfunction, neurogenic bladder, or constipation
- History of pediatric UTI or hydronephrosis
Signs and Symptoms of VUR
- Recurrent UTIs, even after antibiotic treatment
- Fever, especially with no obvious cause
- Foul-smelling urine, cloudy urine, or blood in urine
- Painful urination (dysuria)
- Bedwetting or daytime wetting in toilet-trained children
- Abdominal or flank pain
- Child nephrolithiasis (kidney stones) in long-standing cases
- Failure to thrive or poor weight gain in infants
When Should VUR Be Suspected?
- A history of two or more UTIs
- Hydronephrosis detected in prenatal or postnatal ultrasound
- Sibling or parent with VUR
- Recurrent bedwetting or child urinary incontinence
- Signs of renal scarring on imaging
Diagnosis of Vesicoureteral Reflux
- Ultrasound (USG KUB) – detects kidney swelling and structural abnormalities
- Micturating cystourethrogram (MCUG/VCUG) – gold standard to detect reflux
- DMSA Scan – assesses kidney scarring or function
- Urine routine and culture – to confirm presence of UTI
- Uroflowmetry or urodynamic studies – if bladder dysfunction is suspected
Treatment Options for VUR
Observation
- For low-grade VUR (Grade I–II)
- Many children outgrow reflux as they grow
- Regular follow-ups, ultrasounds, and monitoring of symptoms
Medical Management
- Antibiotic prophylaxis to prevent infections
- Management of constipation, bladder dysfunction, or dysfunctional voiding
- Behavioral therapy for bedwetting and proper toileting
Surgical Treatment
Recommended in cases of:
- High-grade reflux (Grade III–V)
- Reflux that does not resolve with age
- Recurrent infections despite antibiotics
- Development of kidney scars or hydronephrosis
Types of Surgeries
- Open ureteric reimplantation – highly effective, especially in complex cases
- Endoscopic treatment (Deflux injection) – less invasive, day-care procedure
- Robotic-assisted ureteric reimplantation – modern, precise, and faster recovery
Post-Surgical Recovery
- Most children resume normal activities in a few days
- Follow-up ultrasounds and urine cultures are important
- Monitor for recurrence of UTI, bedwetting, or any signs of obstruction
- In some cases, long-term bladder management may be needed
Pediatric Urology & Nephrology Collaboration
- Hypertension due to kidney damage
- Proteinuria or abnormal kidney function
- Require monitoring by both pediatric nephrologists and urologists
Integrated care ensures that the child’s urinary tract, bladder, and kidneys are all managed holistically.
Why Early Treatment of VUR Is Crucial
- Prevents kidney damage and renal failure
- Reduces risk of recurrent infections and sepsis
- Ensures normal bladder development and toilet habits
- Avoids long-term issues like hypertension, nephrolithiasis, and incontinence
Vesicoureteral reflux is more than just a urinary issue—it can impact a child’s kidney health for life. With proper evaluation, medical management, or surgery, VUR can be effectively treated. If your child is suffering from recurrent UTIs, bedwetting, or has a known structural issue, consult Dr. Sadashiv Bhole, one of the best pediatric urologists in Nagpur, for accurate diagnosis and lifelong protection of your child’s urinary health.
