Vesicoureteral Reflux (VUR) | Diagnosis & Treatments

How is vesicoureteral reflux diagnosed?

Vesicoureteral reflux (VUR) can only be diagnosed by a test called a cystogram, in which a catheter is placed through the urethra into the bladder, and the bladder is filled with fluid. This procedure allows doctors to see the reverse flow of urine toward the kidney. There are two types of cystograms:

  • voiding cystourethrogram (VCUG): an x-ray test that examines your child’s urinary tract. The bladder is filled with contrast using a catheter, and x-ray pictures are taken. The images show if there is any reverse flow of urine into the ureters and kidneys.
  • radionuclide cystogram (RNC): this test is performed similarly to a VCUG with a catheter placed in the urethra and bladder, except a different fluid is used to highlight your child’s urinary tract.

A cystogram is most commonly done in a child who has had a UTI but may also be performed in infants who have hydronephrosis (fluid in the kidneys) — a condition detected by ultrasound before birth.

There are other tests that are sometimes performed in children with VUR including:

If a child is suspected of having a urinary tract infection (UTI), the urine needs to be sampled using special techniques to avoid contamination and false test results. For younger children and infants, this usually means passing a catheter into the bladder to obtain a urine sample. In some cases, a bag will be placed on the child to collect urine, although this method has a high rate of false results. In older, toilet-trained children, the child can urinate into a cup.

What are the treatment options for vesicoureteral reflux?

Based on the results of diagnostic vesicoureteral reflux (VUR) testing, a physician will usually assign a number score for the VUR. Scores range from one to five or one to three, depending on the type of test performed. The higher the number or score, the more severe the VUR.

Children with mild VUR will likely improve over time and are less likely to need surgery. Once VUR resolves itself, it is important for parents to know that their child may still get UTIs.

If a child has more severe VUR or gets frequent kidney infections, despite preventative antibiotics, he or she may need surgery to correct the VUR. The severe form of VUR is less likely to resolve on its own.

Ureteral reimplantation surgery

Ureteral reimplantation surgery is a surgical procedure where the connection between the ureter and the bladder is reconstructed to prevent VUR.

Endoscopic treatment

Endoscopic treatment is an option for some children who have lower grades of VUR. The procedure is performed on an outpatient basis under general anesthesia.

The doctor inserts a small telescope into the bladder through the urethra (the tube connects the bladder to the outside) and injects a small amount of gel-like material under the opening of the ureter. The injected material partially closes the opening and prevents the urine from going backward toward the kidney.

The success rate of this procedure is about 75 percent, and there are very few complications. However, we do not know how long the results will last, since some children can have recurrence of their VUR months or years later. Although there are some advantages to endoscopic treatment, it is not always the best option.

Robotic surgical treatment

Robot-assisted laparoscopic surgery is performed by inserting small instruments through several tiny incisions in the abdomen. This procedure is normally performed in patients that require repeat surgery for VUR or to treat VUR in adolescents and young adults. The approach is rarely performed in younger children because the success rate for open surgery is better (about 98 percent) and with few complications.

Continued technical improvements in robotic surgical treatment will likely provide good alternatives to open surgery in the future. We have made great progress with robotic-assisted laparoscopic surgery for VUR.