Urinary reflux, also called vesicoureteral reflux (VUR), describes backward flow of urine through the ureters that run from the kidneys to the bladder. Urinary reflux can be present either at birth (primary) or develop as the child grows (secondary).

Primary urinary reflux is more common than secondary. Children born with urinary reflux have a defect in a valve that is supposed to prevent urine from flowing out of the bladder and into the ureters. Children often outgrow primary urinary reflux as the ureters get longer and straighter. However, urinary reflux can cause permanent kidney damage.

The pediatric urologists with Norton Children’s Urology, affiliated with the UofL School of Medicine, are fellowship trained and experienced in providing urology care to children and teens. Norton Children’s urologists bring skill, respect and sensitivity to caring for your child’s urological needs.

Urinary Reflux Risk Factors

Age, assigned gender at birth and family history are three of the most important factors used to determine a child’s risk for urinary reflux. Children younger than age 2 are much more likely to have the condition than older children. Primary urinary reflux affects children assigned male at birth more often, but secondary urinary reflux is more common among children assigned female at birth. About 1 in 4 siblings of children with the condition also have it. About 1 in 3 children with the condition have a parent who had it as well.

Kidney scarring, high blood pressure and kidney failure are the most severe complications of urinary reflux. The most common complication is a urinary tract infection (UTI).

Diagnosing Urinary Reflux

A voiding cystourethrogram (VCUG) test uses catheters and X-rays to show any irregular urine flow and help diagnose urinary reflux.

Urinary Reflux Treatment

Treating urinary reflux can include behavior changes, medication and surgery to prevent damage to the kidneys. Your child’s pediatric urologist will work with you and will recommend the best treatment option considering your child’s health history, age and other factors.

• Antibiotics help prevent bacteria growth and infection. These do not eliminate urinary reflux, but can keep the child healthy while they outgrow the condition.
• Bulking injections reinforce the bladder wall to help prevent urine from traveling back up the ureters.
• Behavioral changes can be effective in preventing urinary tract infections (UTIs). These changes can include:
  • Drinking more fluids
  • Regular emptying of the bladder
  • Frequent diaper changes to prevent bacteria spread
  • Wiping from front to back
• Surgery may be required for children with severe or repeated UTIs that result from urinary reflux. Options include minimally invasive endoscopic surgery or conventional open surgery. The operation would aim to strengthen the bladder’s ability to prevent urine from re-entering the ureters and kidneys.

UTI Symptoms in Infants

• Prolonged fever
• Sluggish behavior
• Diarrhea
• Extended appetite loss
• Vomiting that is either more frequent or more forceful than normal spit up

UTIs in infants may be more difficult to notice. If you believe your baby or child may have a UTI, see your child’s health care provider to ensure the condition does not worsen.

UTI Symptoms in Children

• Frequent urge to urinate
• Burning feeling during urination
• Blood or strong odor in urine
• Loss of bladder control
• Fever
• Pain in the lower back or abdomen

Untreated UTIs can lead to kidney infections, which may cause permanent scarring in the kidneys.