

Some infants and young children suffer from a common health issue known as vesicoureteral reflux (VUR) — a condition where urine flows backward from the bladder into the ureters or even the kidneys, instead of exiting the body normally. While this condition may resolve on its own as the child grows, in some cases, it requires careful monitoring and treatment to avoid serious complications like recurrent urinary tract infections or kidney damage.In this Dalili Medical article, we’ll explain everything you need to know about vesicoureteral reflux in children: its causes, symptoms, diagnostic methods, and the latest treatment options — whether medical or surgical — along with important tips to help protect your child's urinary health.
Ureteral dilation surgery is not always dangerous, but like any surgical procedure, it comes with some risks, including:
Problems related to anesthesia.
Bleeding or blood loss during the surgery.
The possibility of blood clots forming.
Infection (sepsis) at the site of surgery.
Inflammation or scarring in the area of the wound.
However, when performed at a trusted medical center and by a specialized doctor, these risks are minimal.
Ureteral stricture can be mild and easy to treat, but if left untreated, it may lead to serious problems, such as:
Recurrent urinary tract infections.
Severe pain and fever.
Kidney failure in severe cases.
Sepsis, which can be life-threatening.
That’s why it’s important to consult with a doctor as soon as you notice any symptoms.
Under normal circumstances, urine flows from the kidneys to the bladder through the ureters, and there’s a valve that prevents urine from flowing back to the kidneys.
However, in some children, this valve doesn’t close properly, causing urine to flow backward from the bladder to the ureter, and sometimes back to the kidneys. This is called vesicoureteral reflux, which can lead to:
Recurrent urinary infections.
Pressure on the kidneys.
Kidney damage or kidney failure if left untreated.
If the dilation is mild, it may resolve on its own after a few months post-birth with just monitoring. However, if there is an obstruction or another underlying cause, the doctor may decide that surgery is necessary.
Mild reflux cases are often treated with prophylactic antibiotics and continuous monitoring to avoid urinary tract infections.
The main cause is the entry of bacteria into the urinary tract, which can reach the bladder or even the kidneys, causing an infection. Normally, the body eliminates the bacteria when urinating, but if the bacteria stay in the urinary tract, an infection occurs.
If your child experiences any of the following symptoms, you should see a doctor immediately:
High fever or chills.
Nausea or vomiting.
Pain in their abdomen, side, or back.
Foul-smelling or unusual urine.
Frequent urination or a burning sensation when urinating.
Leaking urine or difficulty controlling urination.
Ureteral swelling typically occurs due to an obstruction in the urinary tract, which causes urine to accumulate behind the obstruction, thereby applying pressure to the ureter and enlarging it.
Common causes of obstruction include:
Kidney or ureteral stones: This is a very common cause.
External pressure on the ureter: Such as a tumor or swelling of a nearby organ.
Infections or congenital abnormalities in the urinary tract in children.
Treatment depends on the severity of the condition and the cause of the obstruction. Common procedures include:
Urinary catheterization: This is a tube inserted to drain accumulated urine and reduce pressure on the kidneys.
Stone removal: If the obstruction is due to kidney or ureteral stones, the doctor may remove them using laser treatment or surgery.
Surgical intervention: In severe cases or when there is a permanent obstruction or congenital defect.
In a healthy body, urine flows from the kidneys to the bladder via the ureters. When a child urinates, it exits the bladder into the urethra and out of the body.
However, in the case of vesicoureteral reflux, urine flows backward from the bladder to the ureter, and sometimes to the kidneys. This can lead to:
Recurrent urinary infections due to bacteria returning to the kidneys.
Scarring or damage to the kidneys if left untreated.
Causes of Vesicoureteral Reflux:
Vesicoureteral reflux occurs when urine flows back from the bladder into the ureters or kidneys. This happens in children for several reasons, including:
Congenital defects in the ureter: Some newborns are born with underdeveloped ureters, leading to urine flowing backward from the bladder to the kidneys and causing their dilation. These issues are often genetic.
Obstruction in the urinary tract: Any blockage in the urinary tract can prevent urine from exiting properly, causing it to flow backward and apply pressure to the kidneys. Obstruction can be caused by:
Nerve damage.
External pressure on the ureter from a nearby organ or tumor.
Malfunction of the valve between the ureter and bladder: Normally, this valve prevents urine from returning to the ureter. However, a congenital defect or problem with the valve may allow urine to flow back and cause reflux.
Bladder obstruction due to other diseases: Such as bladder conditions or infections that prevent full emptying, pushing urine back into the ureters.
Genetic factors: If there is a family history of urinary reflux, the likelihood of the child developing this condition increases.
Spinal cord or nerve problems: Conditions like spina bifida (a birth defect in the spine) that affect the body's ability to control bladder function.
Congenital defects in the urinary system: Some children are born with issues or abnormalities in their kidneys or ureters, increasing the chance of urinary reflux.
Bladder and urination issues: Like frequent urination or chronic constipation, which can put pressure on the bladder and affect normal urine flow.
Urinary reflux is classified into five grades based on its severity:
Grade 1: Urine flows back into the ureter only, and it is usually not dangerous.
Grade 2: Urine flows back to the kidney, but it does not cause dilation.
Grade 3: Urine flows back to the kidney and causes mild dilation in the ureter.
Grade 4: Moderate dilation of the ureter and renal pelvis.
Grade 5: The most severe grade, where there is severe dilation and bending of the ureter, with significant dilation of the kidneys.
Be alert for the following symptoms to detect the issue early and treat it effectively:
Sudden fever without any clear cause.
Frequent urination or an urgent need to urinate.
Involuntary urination, especially at night.
A burning sensation during urination.
Abdominal or flank (side) pain.
Dark urine, or urine with blood or an unusual smell.
Loss of appetite or unexplained weight loss.
In some cases, there might be swelling in the lower abdomen due to bladder enlargement.
If neglected, it can lead to severe complications such as:
Kidney damage or scarring.
High blood pressure.
Kidney failure in severe cases.
Sometimes, a baby may cry or appear unwell without any clear reason, and symptoms may not always be obvious. This is where the doctor comes in, using several precise tests to determine whether the child is suffering from urinary reflux.
Key tests for diagnosing urinary reflux:
Ultrasound
This is performed during pregnancy as part of routine prenatal care, helping to identify kidney or urinary tract issues early on. It can also be done after birth to ensure the kidneys, ureters, and bladder are functioning properly without any dilation or obstruction.
Urine Analysis
This is one of the most important tests to detect urinary tract infections. It shows if there is blood or protein in the urine, which may indicate infection or kidney dysfunction.
Blood Tests
These tests measure the levels of waste materials that the kidneys should be eliminating. If these levels are high, it could indicate kidney dysfunction possibly caused by urinary reflux.
Voiding Cystourethrogram (VCUG)
This is a precise test performed on children suspected of having urinary reflux. The bladder is filled with a special liquid through a catheter, and then the child urinates while the doctor takes X-ray images to observe where the urine is flowing. This helps determine if urine is refluxing back into the ureter or kidneys.
Echo-Enhanced Cystosonography (Ultrasound with Contrast)
This is a variation of ultrasound that uses a special contrast agent to enhance images. It does not involve radiation, making it safe for children. It helps accurately assess the condition of the bladder and ureters.
Vesicoureteral reflux in children has two main classifications: by cause and by severity. Each classification helps doctors determine the best treatment plan.
First Classification: Types of Reflux Based on Cause
Primary (Congenital) Vesicoureteral Reflux
This type is present from birth and is caused by a congenital defect in the valve that connects the ureter to the bladder. This valve normally prevents urine from flowing back into the ureter, but when there is a defect or the ureter is too short, reflux occurs. This type of reflux usually improves on its own as the child grows and the valve matures, especially within the first six months. In some cases, the problem may be caused by a congenital kidney issue.
Secondary Vesicoureteral Reflux
This type occurs after birth due to issues in the bladder or urinary tract, such as:
Bladder or urethral obstruction.
Recurrent urinary tract infections or bladder infections.
Previous surgery in the urinary tract.
Nerve damage or weakness in the bladder.
This type requires treatment of the underlying cause in order to manage urinary reflux.
The higher the number, the more severe the condition and its impact on the kidneys. Here are the details for each grade:
Grade 1:
The urine only flows back into the ureter, not reaching the kidney.
This is a very mild condition and usually improves without major intervention.
Grade 2:
The urine reaches the renal pelvis, but without any dilation or damage.
This is also a mild condition and may improve over time.
Grade 3:
The urine refluxes to both the ureter and the kidney, and mild dilation occurs.
Slight bending of the ureter might also appear.
Grade 4:
Moderate dilation of the ureter and kidney, with more noticeable bending or deformities.
This requires careful monitoring and organized treatment.
Grade 5:
The most severe grade, where there is significant dilation of both the ureter and renal pelvis.
There is clear damage to the kidney tissue, requiring prompt medical intervention, either medical or surgical.
The treatment of urinary reflux depends on the severity of the condition, the child’s age, and the presence of complications such as kidney infections or urinary tract infections. In mild cases, medication may be sufficient, but in more severe cases, surgical intervention or lifestyle changes may be necessary.
1. Medication Treatment
This is the first step in treating mild to moderate cases, mainly to prevent urinary tract infections and reduce symptoms:
Prophylactic Antibiotics:
These are prescribed in low doses to prevent recurrent urinary infections. They are essential in mild urinary reflux and are used for long periods with ongoing monitoring.
Antispasmodic Medications (e.g., Timosafen):
These help calm the bladder if it experiences spasms or contractions, reducing the discomfort during urination.
Anti-inflammatory Drugs (e.g., Ibuprofen):
If the child complains of abdominal pain or infections, these medications reduce pain and inflammation, providing relief.
2. Surgical Treatment
Surgery is the solution for severe cases or those that don’t respond to medication. The main surgical interventions include:
Valve Repair between Ureter and Bladder:
The malfunctioning valve between the ureter and bladder is repaired or replaced, stopping the urine from refluxing.
Ureteral Reimplantation:
In this surgery, the ureter is redirected to ensure proper connection with the bladder and prevent urine reflux.
Bladder Reconstruction or Adjustment:
In cases where the bladder is too weak or small, surgery may be required to increase its size or strengthen its muscles to retain urine naturally.
Laser Procedures:
Laser techniques are used to remove excess tissue that causes urinary reflux.
Ureteral Stenting:
A flexible stent may be placed in the ureter to improve urine flow and prevent reflux, which is removed after the ureter heals.
Laparoscopic Surgery:
Minimally invasive surgery using small incisions and a camera to perform the necessary adjustments to the ureter or bladder.
3. Monitoring and Follow-Up
In mild cases, the doctor may opt for regular monitoring rather than immediate treatment, including:
Periodic ultrasounds or urine tests.
Monitoring symptoms like recurring fever or pain.
Regular urine analysis to check for infection.
4. Lifestyle and Habit Changes
Simple lifestyle changes can improve the child’s condition and reduce symptoms:
Encourage regular bathroom visits and discourage holding urine for long periods.
Ensure the child drinks enough water daily.
Limit sugary or caffeinated drinks like sodas and fruit juices.
Treat constipation, as it can put pressure on the bladder and worsen the condition.
5. Physical Therapy (Bladder Exercises)
In some cases, the doctor may recommend bladder exercises to improve bladder function and reduce spasms that can cause reflux.
In cases where medication fails or the symptoms are severe, surgical treatment is often necessary. The goal of surgery is to fix the abnormalities or deformities causing urinary reflux and prevent future complications like recurrent urinary infections or kidney damage. Here are the most common surgical treatments used:
1. Urinary Sphincter Repair:
This surgery corrects the defect in the sphincter that controls the flow of urine from the ureter to the bladder, preventing reflux.
2. Ureteral Reimplantation:
In this surgery, the ureter is redirected and properly reattached to the bladder, ensuring proper urine flow and preventing reflux.
3. Bladder Expansion or Repair:
In some cases, surgery is required to increase the bladder's size or strengthen its walls, allowing it to retain urine properly.
4. Laser Procedures:
Laser techniques may be used to shrink or remove excess tissue in the ureter or bladder that contributes to urinary reflux.
5. Ureteral Stenting:
A stent is inserted into the ureter to facilitate urine flow and prevent reflux, staying in place until the ureter heals.
6. Laparoscopic Surgery:
This minimally invasive surgery uses small incisions to insert a camera and surgical tools to correct the problem, providing a less invasive option for children.
Regular Urination:
It’s important to encourage the child to urinate regularly and not hold urine for extended periods. This helps maintain bladder health and reduces pressure on it.
Healthy Diet:
Avoid foods or drinks that can irritate the bladder and cause infections, like carbonated beverages or caffeinated drinks.
Increase Fluid Intake:
Ensure the child drinks enough water every day to encourage regular urination and clear the urinary tract of potential infections.
Regular Monitoring and Follow-Up:
Continuous medical follow-up is necessary to evaluate the child’s condition periodically and ensure no complications, like kidney infections or loss of kidney function, occur.
Bladder Therapy:
Some doctors may recommend bladder exercises to improve its function, helping the child urinate more regularly and effectively.
Many natural herbs can help treat urinary reflux, offering health benefits to improve urinary system function and reduce symptoms. Here are some of the most effective herbs for treatment:
1. Parsley Tea:
Parsley is one of the best herbs for treating urinary reflux due to its diuretic properties, helping cleanse the urinary system.
Preparation: Boil an appropriate amount of parsley in water and drink daily to improve urinary health.
2. Barley and Garlic Tea:
Barley helps improve bladder performance and reduce urinary retention, while garlic strengthens the immune system.
Preparation: Add 3 crushed garlic cloves to boiled barley water, let it cool, and drink it on an empty stomach. Avoid soft drinks for best results.
3. Celery Tea:
Celery helps eliminate excess fluids and improves bladder function.
Preparation: Add a tablespoon of celery to a cup of boiling water, simmer for a few minutes, and drink once it cools.
4. Purslane Tea:
Purslane has anti-inflammatory properties and promotes urinary tract health.
Preparation: You can brew purslane as a tea or add it to food like salads.
5. Carrot Seeds:
Carrot seeds help improve bladder function and reduce urinary retention.
Preparation: Soak carrot seeds in boiling water for 3-4 hours, then drink it chilled or warm.
6. Frankincense Tea:
Frankincense is beneficial for treating urinary reflux and improving urinary system health.
Preparation: Soak frankincense in hot water for a day, strain it, and sweeten with honey before drinking.
7. Nettle Tea:
Nettle helps cleanse the urinary system and reduces urinary tract inflammation.
Preparation: Add a small amount of nettle to a cup of boiling water, let it steep for 10 minutes, and drink it at night.
8. Fennel Tea:
Fennel helps soothe urinary tract spasms and improves regular urination.
Preparation: Boil fennel in water, drink 3 cups a day to improve urinary system function.
9. Dandelion Root Tea:
Dandelion root helps resist urinary retention and improves kidney and bladder health.
Preparation: Boil dandelion root and drink it like tea, or add it to salads.
10. Pumpkin Seeds:
Pumpkin seeds improve bladder function and reduce urinary reflux symptoms.
Preparation: Boil pumpkin seeds after peeling them for 15 minutes and drink a cup daily for 10 days.
11. Allium (Onion):
Onion helps treat urinary inflammation and relieves urinary reflux symptoms.
Preparation: Boil onion roots in water for 15 minutes and drink 3 cups daily until recovery.
12. Goldenrod Herb Tea:
Goldenrod is effective in treating urinary tract issues, particularly urinary reflux.
Preparation: Boil goldenrod herb in water and drink 3 cups daily.
Vesicoureteral reflux (VUR) is a condition that affects infants and young children, where urine flows backward from the bladder into the ureters or even the kidneys, instead of leaving the body naturally. If this issue occurs, the child should be followed up with a pediatric specialist or a pediatric urologist.
A pediatric urologist is a doctor specialized in diagnosing and treating urinary and reproductive system problems in children. If the vesicoureteral reflux requires close monitoring or surgical intervention, this specialist will be the most suitable.
In some cases, the child may be referred to other doctors, such as:
Pediatrician: To help with the initial diagnosis and general follow-up.
Nephrologist: If the reflux is affecting kidney health and requires detailed monitoring.