Vesico Ureteric Reflux

What is Vesicoureteric Reflux?

Vesicoureteric reflux occurs when the urine travels back upwards to the kidneys from the bladder. This is due to a defective valve at the lower end of the ureter, (the tube which joins the kidney to the bladder). This defect causes a backflow of urine when the bladder contracts to empty. The result of this backflow may be higher pressure in the kidney, which can cause hydronephrosis, and in addition, the ability for bacteria to travel up to the kidney from the bladder, resulting in the potential for severe urinary tract infection. A urinary tract infection within the kidney can cause secondary damage and scarring to the kidney itself, which may have long-term implications for renal function and high blood pressure in later life.

Vesicoureteric reflux may also be part of a mal-development of the kidney and its drainage into the bladder and it is common in a case diagnosed early in life, to have a small, non-functioning kidney, which rather than being damaged by infection, actually has not developed properly.

Who is Affected?

Vesicoureteric reflux probably affects about 1 in 100 children. In many of these, it may not lead to significant complications and may not require any surgical intervention.

How is it Diagnosed?

The backflow of urine from the bladder to the kidney can be most clearly demonstrated by placing dye inside the bladder through a catheter. Clearly, this is an invasive procedure, but by filling the bladder and seeing the backflow of urine, reflux can be confirmed. This test is therefore commonly offered to children who have had a urinary tract infection in the first year if life. In children over 1 year, catheterisation is an unpleasant and memorable experience, which we would rather avoid. In older children, indirect forms of detecting reflux can be used, which obviate the need for a catheter – (MAG3 indirect cystogram). Occasionally, a small procedure, such as a cystoscopy, is also required to confirm the presence of reflux.

What is the Treatment?

Vesicoureteric reflux can be conservatively treated with just antibiotics and it does improve as the junction between the ureter and the bladder matures with growth and development. Alternatively, a simple procedure, in which a small injection is given inside the bladder, can stop the reflux. More rarely nowadays, an open operation to rejoin the ureters to the bladder may be required.