Vesicoureteral Reflux Program Overview

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Families from across the U.S. and around the globe come to the Department of Urology at Boston Children’s Hospital for their children’s care. Ranked #1 in urology by U.S.News & World Report, our specialists diagnose, treat and care for infants, children and adolescents with issues affecting the urinary tract, bladder and kidneys, including pediatric vesicoureteral reflux.

At Boston Children's Hospital, our main goal for treating vesicoureteral reflux (VUR) is to prevent infections that might affect the kidneys and possibly cause kidney damage. Our Department of Urology provides a comprehensive approach to the management of vesicoureteral reflux from initial diagnosis to treatment and follow-up care.

Many children may need no more than antibiotics and regular follow-up imaging tests. However, if surgery is necessary, your child will have access to the latest procedures, including minimally invasive surgery.

What is vesicoureteral reflux?

Vesicoureteral reflux, or VUR, occurs when urine flows in the wrong direction out of the bladder, backing up into the ureters and kidneys.

Normally, urine flows down from the kidneys, passing through tubes called the ureters, and then enters the bladder. The urine then exits the body through the urethra. In most children, this is a one-way process, and urine does not move in the wrong direction from the bladder into the ureters and kidneys. But if your child has vesicoureteral reflux, the urine does move backward into the ureters and kidney. Some children only have mild VUR, while others have large amounts of urine moving backward into their kidneys.

Although VUR by itself is not usually painful, VUR can become a problem if the child develops a urinary tract infection in his or her bladder. In such an infection, the bacteria are carried backwards from the bladder to the kidneys, and this can result in serious infection and possibly damage to the kidneys. The child may also become quite ill.

How common is vesicoureteral reflux in children?

VUR is a condition that affects about 1-3 percent of all children overall. However, there are certain groups of children in whom VUR is much more common. These include:

  • children who have hydronephrosis, or excessive fluid in the kidneys, and in whom VUR is found on prenatal (before birth) ultrasound. Among this group, VUR is seen in about 15 percent of these children when testing is done after the baby is born.
  • children who have a urinary tract infection, particularly if the infection was associated with a fever. Among this group, VUR is found in 50 to 70 percent of these children.

Our expertise in pediatric urology

Boston Children’s Hospital, named #1 in pediatric urology by U.S.News & World Report 2014-15, is committed to diagnosing and treating children with VUR. Some of the tests for vesicoureteral reflux your child might receive include:

  • Voiding cystourethrogram (VCUG) is an x-ray that examines the urinary tract as the bladder fills and empties. The images will show if there is any reverse flow of urine from the bladder into the ureters and kidneys.
  • Radionuclide cystogram (RNC) is a test that uses radioactive tracers to determine if urine is going from the bladder back to the kidneys, rather than out of the body.
  • Nuclear renal scan with DMSA is a test that uses a tracer injected into the blood stream to get detailed images of the kidneys to look for damage from VUR.
  • Renal ultrasound is a non-invasive imaging test used to determine the size and shape of the kidneys. This test also detects the presence of a mass, kidney stone, cyst, or other obstruction or abnormalities.
  • Blood tests measure function of the kidneys indirectly, based on detection of proteins circulating in the blood.
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