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Vesicoureteral Reflux—Adult

(VUR; Reflux Nephropathy; Chronic Atrophic Pyelonephritis; Vesico-Ureteric Reflux; Ureteral Reflux)

Definition

Vesicoureteral reflux (VUR) is the backward flow of urine. The urine flows from the bladder back into the kidney.
Urine normally flows from the kidneys. It passes through tubes called ureters. It then flows into the bladder. Each ureter connects to the bladder in a way that prevents urine from flowing back up the ureter. The connection is similar to a one-way valve. When this does not work properly, or if the ureters do not extend far enough into the bladder, urine may flow back up to the kidney. If the urine contains bacteria, the kidney may become infected. The back up can also put extra pressure on the kidney, causing damage or kidney failure.
Anatomy of the Urinary System
The Urinary Tract
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Causes

VUR may be caused by:

Risk Factors

Factors that may increase your chance of VUR include:

Symptoms

In most cases, VUR has no obvious symptoms or signs. In some cases, VUR is found after a urinary tract or kidney infection is diagnosed. Symptoms of urinary tract infections include:

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include:
The urinary tract can be evaluated with imaging tests, which may include:

Treatment

The goal for treatment of VUR is to prevent any permanent kidney damage. Treatment options include the following:

Surgery

Endoscopic Injection Into the Ureter
This procedure is a minimally invasive surgery. It is done to correct the reflux. A gel is injected where the ureter inserts into the bladder. This can prevent urine from going back up the ureter. This procedure is done through a small tube called a cystoscope.
Ureteral Reimplantation
This surgery repositions the ureters in the bladder. It can be done in two ways. One way requires making an incision above the pubic bone and repositioning the ureters in the bladder. It can also be done laparoscopically by inserting cameras through small incisions in the abdomen and/or bladder to perform the surgery.

Prevention

VUR cannot be prevented in most cases. However, further complications can be avoided. Seek prompt treatment for bladder or kidney infections. This is particularly important if you have a neurogenic bladder.

RESOURCES

National Kidney Foundation http://www.kidney.org

Urology Care Foundation http://www.urologyhealth.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

The Kidney Foundation of Canada http://www.kidney.ca

References

Valla JS, Steyaert H, et al. Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: A single-centre 5-year experience. J Pediatr Urol. 2009;5(6):466-471.

Vesicoureteral reflux. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 15, 2013. Accessed July 16, 2013.

Vesicoureteral reflux. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/vesicoureteral-reflux-vur/Pages/facts.aspx. Updated June 29, 2012. Accessed July 16, 2013.

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