Vesicoureteric reflux (VUR) is a congenital condition in which urine flows backward from the bladder into the ureters and sometimes up into the kidneys. Normally, a one-way valve mechanism at the junction of the ureter and bladder prevents this backward flow. When this valve is weak or improperly developed, reflux occurs. VUR can lead to urinary tract infections (UTIs), kidney swelling, scarring, and in severe cases, long-term reduction in kidney function.
VUR is commonly diagnosed in infancy or early childhood, especially when a child develops repeated UTIs accompanied by fever. Some children with VUR may have no symptoms, and the condition is detected incidentally during scans done for other reasons. Prenatal ultrasounds may show hydronephrosis, which prompts further evaluation after birth.
Diagnosis is typically made using a voiding cystourethrogram (VCUG), a specialized imaging study where contrast dye is introduced into the bladder to watch for backward flow of urine. Additional tests include renal ultrasound and a DMSA scan to check kidney scarring.
VUR is graded from I to V based on severity. Lower grades (I–III) often improve with age as the urinary system grows and the valve mechanism strengthens. Higher grades (IV–V) are less likely to resolve and may need medical or surgical management.
Treatment aims to prevent kidney infections and protect kidney function. Mild cases may be managed with low-dose daily antibiotics to prevent UTIs until the child outgrows the condition. Parents are educated about hydration, toilet habits, and early signs of infection. Severe cases or those with recurrent infections may require surgical correction. The most common surgery is ureteric reimplantation, which reconstructs the valve mechanism. Another minimally invasive option is injection of a bulking agent at the valve site to prevent backflow.
Most children with VUR have an excellent prognosis when managed appropriately. Regular monitoring through ultrasound and follow-up visits is important to track healing and detect any kidney damage early.
