Dr. Amrish Vaidya
Vesico ureteric reflux


What is vesicoureteric reflux  (VUR) ?

Urine that is formed in the kidneys travels down tubes called ureters, into the urinary bladder. Here, urine is stored till the bladder is full. When urine is to be passed, the bladder contracts. At this point, the urethra opens up and simultaneously, the ureteric openings close, by a valve mechanism. This allows the urine to flow out, and not back up the ureters, towards the kidney.

When this valve mechanism does not function well, some urine may pass up - this is called vesico ureteric reflux, or VUR.


Why does reflux happen?

In some children, the valve mechanism is not developed properly. In others, the bladder may not function well, which leads to very high pressures in the bladder which can overcome the valve at the ureteric opening. Both of these can mature as the child grows, and the reflux may cease.

In other situations, the reflux is secondary to other problems, which are generally structural, and may need surgery.


Can reflux cause harm?

Reflux may make the child prone to urinary infections . Also, if this infection affects the kidney, it  can causedamage to the kidney. Repeated infections can lead to significant kidney damage, which can cause kidney failure in the long term

How is reflux diagnosed ?

Reflux is generally diagnosed by performing a micturating cysto-urethrogram , or a MCU. This test is also called a Voiding Cystourethrogram ( VCUG).

Additionally, a DMSA renal scan, which is a radionucleide scan can pick up renal scars. Both these tests may be used.

Finally, your doctor may recommend other tests like blood tests to see how the kidneys are working, urine tests to check for infection, and other imaging studies like sonography.
Is a MCU really necessary?

A MCU is the standard and most accurate test to diagnose reflux. It may not be necessary in all cases, and is used in conjunction with a DMSA scan, but if recommended, you should have it done.

Many parents are very apprehensive of this test. It is uncomfortable for a child, but not really painful. It is quick, safe and informative, and so should be done when needed.
Does reflux need treatment?

Some kinds of reflux can be observed, in the expectation that spontaneous resolution may occur as the child grows. However, during this period of observation, it is important to avoid urinary infections. For this, a small dose of antibiotic will be prescribed. It is very important to take this daily, and not miss any doses. It is also important to ensure that your child is not constipated. Sometimes, a circumcision may be suggested to try and minimize the chances of a urine infection.

In other situations, drugs to relax the bladder may be advised.

If it is decided that more active measures need to be taken, then a cystoscopy can be performed, and an injection can be given through the cystoscope. This injection is of a substance called deflux, and this cures reflux in many cases. Sometimes, more than one injection may be necessary.

In a few cases, your doctor may recommend surgical correction of the reflux

MCU study showing a child passing urine (green arrow). There is urine returning towards the kidneys (red and blue arrows)
MCU study showing a child passing urine (green arrow). There is urine returning towards the kidneys (red and blue arrows)
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