Symptoms
VUR itself often doesn't cause noticeable symptoms. Symptoms are usually related to urinary tract infections (UTIs) that are more common in individuals with VUR. These symptoms can include:
Fever
Frequent urination
Painful urination (dysuria)
Abdominal pain
Back pain
Blood in the urine (hematuria)
Bedwetting (in children who are toilet trained)
Causes
VUR can be either primary or secondary.
Primary VUR: This is the most common type and is caused by a defect in the valve-like mechanism at the junction where the ureter enters the bladder. The ureter may be too short or positioned abnormally within the bladder wall. It's often congenital (present at birth).
Secondary VUR: This is caused by a blockage or malfunction in the urinary tract that increases pressure in the bladder. This increased pressure can force urine backward into the ureters. Common causes include:
Posterior urethral valves (in males)
Bladder dysfunction (neurogenic bladder)
Infrequent or dysfunctional voiding habits
Medicine Used
Medications are not typically used to directly "treat" VUR itself, especially in the context of considering surgery. However, antibiotics are used prophylactically (preventatively) to reduce the risk of UTIs while waiting for VUR to resolve spontaneously (especially in lower grades of VUR) or while awaiting surgery. These antibiotics are typically:
Trimethoprim-sulfamethoxazole (Bactrim, Septra)
Nitrofurantoin (Macrobid, Macrodantin)
Cephalexin (Keflex) Important: Antibiotic choice and dosage are determined by the doctor based on age, weight, and kidney function. These antibiotics are not used after surgery to correct VUR unless there are ongoing infections. Pain medications may be used post-operatively, as well as medications to prevent bladder spasms.
Is Communicable
Vesicoureteral reflux (VUR) is not communicable. It is not caused by an infectious agent and cannot be spread from person to person. It's a structural or functional problem within the urinary system.
Precautions
Precautions, especially related to managing VUR and preventing complications, generally include:
Adherence to Antibiotic Prophylaxis: If prescribed, give antibiotics exactly as directed to prevent UTIs.
Good Hygiene: Proper hygiene practices (especially wiping front to back for girls) can help reduce the risk of UTIs.
Adequate Hydration: Encourage sufficient fluid intake to help flush bacteria from the urinary system.
Regular Voiding: Encourage regular and complete bladder emptying. Address any constipation issues, as this can contribute to bladder dysfunction.
Follow-up with Physician: Regular follow-up appointments with a nephrologist or urologist are essential to monitor the VUR and kidney health.
Post-Operative Care: Following all post-operative instructions carefully after surgery to ensure proper healing and minimize complications.
How long does an outbreak last?
VUR itself isn't an "outbreak." The symptoms associated with VUR are usually related to urinary tract infections (UTIs). A UTI, if treated promptly with antibiotics, typically lasts:
Uncomplicated UTI: Symptoms usually improve within 1-2 days of starting antibiotics and are typically gone within 5-7 days.
Kidney Infection (Pyelonephritis): This is a more serious infection. Symptoms may take longer to improve (several days), and the full course of antibiotics is usually 10-14 days.
How is it diagnosed?
VUR is typically diagnosed using the following tests:
Voiding Cystourethrogram (VCUG): This is the primary diagnostic test. A catheter is inserted into the bladder, and the bladder is filled with a contrast dye. X-rays are taken while the bladder fills and while the person urinates. This allows the doctor to see if urine is flowing backward into the ureters. The VCUG also allows the doctor to grade the severity of the reflux.
Renal Ultrasound: This imaging test uses sound waves to create pictures of the kidneys and bladder. It can help identify kidney abnormalities or hydronephrosis (swelling of the kidneys due to urine backflow).
Dimercaptosuccinic Acid (DMSA) Scan: This nuclear medicine scan helps evaluate kidney function and identify any scarring from previous infections.
Urine Analysis and Culture: To detect the presence of infection.
Timeline of Symptoms
The timeline of symptoms varies depending on whether a UTI is present and its severity.
Without UTI: VUR itself often has no noticeable symptoms.
With UTI:
Initial Symptoms (1-2 days): Fever, frequent urination, painful urination, abdominal/back pain may appear suddenly.
Progression (2-3 days): Symptoms may worsen if untreated. Blood in urine, vomiting, or high fever may develop.
With Antibiotics (1-2 days): Symptoms should start to improve after starting antibiotics.
Resolution (5-7 days): Most symptoms should resolve within a week with appropriate antibiotic treatment for a UTI. Pyelonephritis may take longer.
Important Considerations
Severity Grading: VUR is graded from I to V, with I being the mildest and V being the most severe. Treatment decisions are based on the grade of reflux, age of the patient, and history of UTIs.
Spontaneous Resolution: Many children with lower grades of VUR (I-III) will outgrow the condition as they get older, as the ureterovesical junction matures.
Surgical Options: Surgical intervention is considered for higher grades of VUR (IV-V), recurrent UTIs despite antibiotic prophylaxis, or failure to resolve with conservative management. Common surgical options include:
Open Ureteral Reimplantation: This involves surgically reattaching the ureter to the bladder in a way that prevents reflux.
Laparoscopic/Robotic Ureteral Reimplantation: A minimally invasive approach to ureteral reimplantation.
Endoscopic Injection (Deflux): This involves injecting a bulking agent into the ureterovesical junction to create a valve-like effect.
Long-Term Monitoring: Even after successful treatment (either spontaneous resolution or surgery), long-term monitoring of kidney function and blood pressure is recommended.
Family History: VUR can have a genetic component. Siblings of children with VUR may be screened.