What is vesicoureteral reflux (VUR)?

Vesicoureteral reflux (VUR) is a medical condition in which urine flows abnormally from the bladder back into the ureters (the tubes connecting the kidneys to the bladder) or even up to the kidneys themselves [2]. Normally, the ureters act as one-way valves that prevent urine from flowing upward once it reaches the bladder; however, in cases of VUR, this valve fails to close properly, allowing urine to reflux [2].

This condition is part of a group known as Congenital Anomalies of the Kidney and Urinary Tract (CAKUT), which are conditions present from birth due to abnormal development in the urinary system, and their effects or diagnosis may not appear until later stages of life [2].

Why is vesicoureteral reflux a cause for concern?

The primary danger of this condition is that the urine refluxing from the bladder may carry bacteria into the upper urinary tract (ureters and kidneys), increasing the risk of recurrent urinary tract infections (UTIs). Over time, these recurrent infections or the pressure caused by the refluxing urine can lead to damage to the kidney tissue, which may progress in severe and chronic cases to more serious renal issues, such as kidney failure [2].

Common Symptoms

Often, there are no clear symptoms of VUR itself, but the patient may face complications resulting from it, most notably urinary tract infections. Signs that may indicate a problem requiring medical examination include: unexplained fever, pain during urination, an urgent or frequent need to urinate, or pain in the abdomen or flank area [2]. It is important to note any changes in urination habits, such as difficulty initiating urination or the feeling of incomplete bladder emptying, as these can be early indicators of urinary tract problems [1].

Diagnosis and Medical Management

To diagnose this condition, physicians do not rely on endoscopy as a primary diagnostic tool; rather, they use specialized imaging tests to visualize urine flow (such as a voiding cystourethrogram) to confirm the presence of reflux and determine its grade. A specialist physician may also use cystoscopy in certain cases to evaluate the structure of the bladder and ureters from the inside or to rule out other structural causes that induce obstruction or reflux [3].

Treatment depends on the severity of the case and the patient's age. In some cases, the physician may opt for periodic monitoring and the use of antibiotics to prevent infections until the condition resolves naturally. Conversely, more severe cases may require surgical intervention or the injection of specific bulking agents into the ureter area to enhance the valve's ability to close [3]. For more information on how these issues are evaluated, you can review Ureteral Disorders: Diagnosis, Symptoms, and Treatment Options (Arabic).

When should you seek immediate care?

You should see a doctor immediately if signs indicating an acute urinary tract infection appear, such as a high fever associated with flank pain, a complete inability to urinate, or visible blood in the urine. These are signs that require urgent medical evaluation to prevent permanent kidney damage or systemic complications [1].

Medical references

• The Urinary Tract & How It Works
• Congenital anomalies of kidney and urinary tract: MedlinePlus Genetics
• Cystoscopy & Ureteroscopy