Pediatric Vesicoureteral Reflux

Vesicoureteral reflux (VUR), also known as bladder reflux, occurs when urine flows backwards from your child’s bladder into their ureter or kidney. At Children’s Hospital, our team helps families manage the condition with nonsurgical and surgical options.

The ureters connect the kidneys to bladder. Meant to function as one-way valves, the ureters sometimes don’t develop properly in children. When this happens to one or both ureters, kids can get VUR.

Children ages 2 and younger are more likely to have VUR, but it can also affect older kids. VUR often runs in families and is more common in girls than boys.

The condition usually improves or goes away as children get older, without any lasting effects on their health. But without treatment, some children may experience pain, have frequent urinary tract infections (UTIs) and even develop permanent kidney damage.

Having a child with VUR can bring a lot of questions or concerns. Our pediatric urology team is here to help. Through our team-based approach, we offer a wide range of treatments, from bladder training to advanced surgery, if needed.

Vesicoureteral Reflux Symptoms

Signs of VUR, or bladder reflux, in children include:

Frequent UTIs
Fever
Loss of appetite
Fussiness in small children
Urinary incontinence
Burning sensation during urination
Abdominal pain

When to Seek Care for VUR

If your child gets frequent UTIs or shows other signs of VUR, talk to your pediatrician. Or you can reach out directly to our pediatric urology team.

Vesicoureteral Reflux Diagnosis at MU Health Care

At Children’s Hospital, we offer several advanced tests to diagnose VUR in children. We recommend that your child has these tests after their second UTI with a fever:

Renal (kidney) ultrasound: This test uses soundwaves to show the size and shape of the kidneys. With ultrasounds, we can see if kidneys are swollen, which is a sign of VUR.
Voiding cystourethrogram (VCUG): VCUGs use X-rays to see inside the bladder while it fills and empties. We grade the severity of VUR on a scale from 1 to 5 based on these test results. Grade 1 is the least severe, and grade 5 is the most severe.
Nuclear renal scan: This test uses a small amount of radioactive material to show how the kidneys are working and if they’re scarred.

If your child is diagnosed with VUR, getting treatment can reduce the risk of hydronephrosis (urine buildup in the kidneys) and permanent kidney damage.

Prenatal Screening for VUR

Maternal fetal medicine experts in our Fetal Intervention Center may discover that your baby has VUR during a prenatal screening. If so, we’ll provide education and may suggest medication to reduce your baby’s risk of getting UTIs once they are born.

Vesicoureteral Reflux Treatment at MU Health Care

As part of an academic health system, we have the latest nonsurgical and surgical treatments for VUR. Your child’s treatment plan will depend on their age and severity of VUR.

Nonsurgical Treatments for VUR

We provide several nonsurgical treatments for bladder reflux, including:

Low-dose antibiotics: These medications will help remove certain bacteria in your child’s bladder and help prevent future UTIs. Your child can usually stop taking antibiotics as they get older and their symptoms improve.
Bladder training just for kids: Experts in our voiding improvement clinic can help your child learn behaviors to reduce their risk of UTIs. Some of these habits include good hygiene and drinking the recommended amount of fluids.

We also suggest that your child sees our pediatric urology team every year to monitor their condition. If your child’s VUR doesn’t improve with nonsurgical treatments, we may recommend Deflux injection or ureteral reimplantation surgery.

Deflux Injection

Deflux injections can help prevent urine from flowing the wrong way in your child’s urinary tract. Here’s what you can expect with this minimally invasive outpatient procedure:

Your child will receive general anesthesia to put them to sleep.
Our team will place a tiny camera (cystoscope) into the urethra to see inside the bladder and ureter. No incisions (cuts) are needed.
We will inject a gel called Deflux into the ureter, which “bulks” it up, so urine can’t flow back from the bladder. This keeps urine moving in the right direction.
The procedure takes about 20 minutes, and you can take your child home after they recover in the post-anesthesia care unit (PACU).
One month after the injection, we will perform an ultrasound test to check your child’s kidneys.
Six months later, your child will return for another imaging test to see if they still have VUR.

Robotic or Open Ureteral Reimplantation

Ureteral reimplantation surgery changes how one or both ureters connect with the bladder. Here’s what you can expect with this surgery, which is only available from a highly trained pediatric urologist:

Your child will receive general anesthesia to put them to sleep.
For open ureteral reimplantation, we will make a single incision (cut) on the lower abdomen near the bladder.
For robotic ureteral reimplantation, we will make three to four small incisions (cuts) on the abdomen. Then the surgeon will control small instruments attached to a very precise robot.
We will open the bladder and reposition one or both ureters deeper into the bladder. The surgeon will use dissolvable stitches to close the incisions.
The surgery takes four to six hours.
Your child will spend a night in the hospital and typically go home the next day.
Three weeks after surgery, your child will return for a nuclear renal scan.
Three months after surgery, your child will return for a renal ultrasound.
Six months after surgery, your child will have more imaging to see if they still have VUR.