Normally, urine streams from your kidneys via the ureters to your bladder. When it starts flowing backwards, from your bladder to ureters and then to kidney then it is known as Vesicoureteric reflux or VUR. Vesicoureteral reflux is normally detected in infants and children. It may occur in one or both ureters. When the urine flows backwards, it can carry bacterias from the bladder to the kidney. This might cause a kidney infection that can cause kidney damage as well. The main causes of Vesicoureteral Reflux are heredity and some blockage. In most cases, genetics is the cause. So, if a parent has actually been treated for reflux, there are high chances that their kids will suffer from it too. 

What are the types of Vesicoureteral Reflux?

Vesicoureteral reflux can be of two types, primary or secondary – 

• In Primary VUR, the child is born with a ureter that does not work in coherence with the bladder by birth. The flap-valve that is present in between the ureter and the bladder wall surface does not close properly, so urine refluxes from the bladder to the ureter and even to the kidney in some cases. This kind of VUR can get better as your child ages. 
• Secondary VUR happens when there is a blockage in the urinary system that leads to increase in pressure. It also pushes the urine back from the urethra into the bladder, ureters and also kidneys. 

Can Vesicoureteric reflux cause any complications?

Yes, if not treated well in time, VUR can cause these complications – 

• Kidney damage or renal failure is the primary concern with vesicoureteral reflux. 
• Kidney scarring
• Recurrent UTIs 
• High Blood pressure 

What are the signs and symptoms of VUR?

Urinary system infections or UTI typically take place in people with vesicoureteral reflux. So the symptoms occur because of an underlying problem and not because of VUR – 

• A strong urge to urinate 
• A burning or painful experience while urinating
• Cloudy urine
• Fever
• Discomfort in the flank area or in the lower abdomen
• Nausea, vomiting
• Bed-wetting in case of kids 

How is the diagnosis of VUR made?

• Voiding cystourethrogram – It is like an x-ray of the bladder. It takes about 15 to 20 minutes. In this diagnostic procedure, a catheter is placed in the urethra and a colored liquid is injected till the bladder is full. Then the person is asked to pass urine. Images of the bladder are then taken to see if the color steps up to one or both kidneys.
• Kidney and bladder ultrasound etc.

How is the severity of VUR Measured?

The most common system of grading reflux is – 

Grade I: urine reflux right into the ureter only, not including any other area.

Grade II: urine reflux into the ureter as well as the renal pelvis (where the ureter meets the kidney), without any swelling or hydronephrosis in the kidney

Grade III: reflux right into the ureter and also the kidney, creating light swelling.

Grade IV: lead to moderate swelling in the kidney.

Quality V: causes severe swelling in the kidney and torsion of the ureter.

What are the Treatment Options for VesicoUreteral Reflux?

Treatment alternatives for vesicoureteral reflux depend upon the intensity of the condition. 

• Observation – Children with light cases of primary vesicoureteral reflux may eventually outgrow the problem. In this case, just an observation approach is followed. 
• Medications – As per the symptoms of UTI or Urinary Tract Infection, antibiotics and other medications are given. 
• Behavioural Therapy – Encouraging the patient to use the bathroom frequently. Ensuring that the child has normal bowel and bladder control with training.
• Surgical treatment – In Surgical treatment, the valve between the ureter and the bladder is repaired either laparoscopically or by endoscopy. In the endoscopic surgical procedure, the physician inserts a tool called a cystoscope right into the urethral opening to see inside the bladder. After that, submucosal injection of a bulking agent is given into the bladder. This treats the VUR reflux. Endoscopic surgery is the best treatment for most VUR cases as it is minimally invasive, no cut is made. 

Things to Consider After Treatment

• After surgery, the patient usually remains in the hospital for a couple of days as per the type of surgery performed. 
• A catheter is usually used to drain the bladder during this time.
• You will be discharged after removing the catheter in most cases. 
• After the procedure,  an X-ray is done to make sure that the reflux has been treated fully. Once the reflux is fixed, it does not occur again in most cases. 

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