Carl R. Darnall Army Medical Center - Health Library

Vesicoureteral Reflux—Adult

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

Pronounced: VEH-sih-co-ya-REET-uh-rul REE-flux

Definition

Vesicoureteral reflux (VUR) is the backward flow of urine. It flows from the bladder back into the ureters or kidneys.

Anatomy of the Urinary System
The Urinary Tract

Copyright © Nucleus Medical Media, Inc.

Causes  ^

Urine flows down from the kidneys. It passes through tubes called ureters and into the bladder. This keeps urine moving one way. If there are problems, urine can flow back into the kidney.

Primary causes are a direct result of problems in the urinary system. Secondary causes result from causes that may block normal flow. These may involve:

  • Genetic problems passed down from a parent
  • The ureter doesn’t attach far enough inside the bladder
  • Weak muscles in the lower part of the bladder
  • Blockage that keeps urine from moving freely
  • Nerve problems that keep the bladder from working as it should—neurogenic bladder
  • A bulging muscle where the ureter goes into the bladder—ureterocele
  • Structural problems that happen as you get older

Risk Factors  ^

Your risk is higher if you:

  • Are female
  • Are White
  • Had childhood VUR
  • Have people in your family with the same problems
  • Have structural problems
  • Have frequent urinary tract infections (UTIs)
  • Have bladder or bowel problems

Symptoms  ^

VUR doesn't cause problems in most people. In those that have symptoms, VUR may cause:

  • Frequent or urgent need to use the bathroom
  • Weak stream
  • Stops and starts while passing urine
  • Pain in the lower back or side

Diagnosis  ^

The doctor will ask about your symptoms and health history. Your answers and a physical exam may point to VUR. You may also have:

  • Blood tests
  • Urine tests
  • Ultrasound
  • Dimercaptosuccinic acid (DMSA) scan
  • Voiding cystourethrogram (VCUG)
  • Cystoscopy

Treatment  ^

VUR in adults doesn’t go away on its own. Care centers on treating the cause. This will also help lower the chances of scarring.

Medicines

The doctor may give you medicines to treat:

Surgery

If other methods don’t fix the problems, you may have surgery. This may involve:

  • Cystoscopic injection—a substance is added where the ureter and bladder meet
  • Ureteral reimplantation—to reposition the ureters in the bladder

Prevention  ^

To help lower your chances of VUR:

  • Seek early care if you think you have a UTI.
  • If you are pregnant, go to all your tests as scheduled.
  • Your doctor may give you antibiotics to if you have frequent UTIs.
RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
https//www.niddk.nih.gov

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

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

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

REFERENCES:

Freidman AA, Hanna MK. Vesicoureteral reflux and the adult. In: Wood HM, Woods D, ed. Current Clinical Urology. Springer International Publishing;2015:173-205.

Mattoo TK. Vesicoureteral reflux and reflux nephropathy. Adv Chronic Kidney Dis. 2011;18(5):348-54.

Rollino C, D'Urso L, Beltrame G, Ferro M. Vesicoureteral reflux in adults. G Ital Nefrol. 2011;28(6):599-611.

Last reviewed June 2018 by EBSCO Medical Review Board Adrienne Carmack, MD  Last Updated: 6/13/2018