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Vesicoureteral reflux is also known as bladder reflux. It occurs when urine flows backward from the bladder to the kidney. About 1 percent of children develop this condition, and most of them are girls. Bladder reflux isn’t always serious, but it can be. It can, in some cases, lead to infections and scarring of the kidney which may interfere with the growth of your child’s kidneys. It can also cause problems such as high blood pressure and lack of urine control.
Symptoms and diagnosis
Recognizing symptoms, making a diagnosis
Children might have bladder reflux without having symptoms. If they do have symptoms, doctors will likely advise testing. They could suggest testing siblings of a child with the condition since they have an increased chance of having it.
The most common symptom of bladder reflux is frequent urinary tract infections (UTIs). UTIs can cause:
Burning or discomfort while urinating
Foul smelling urine that may appear cloudy
Strong sudden urges to urinate
Other symptoms can include trouble controlling urine, bedwetting and bowel problems, such as constipation.
We can use several tests to diagnose bladder reflux:
Studying urine in a lab can help doctors learn if there might be an infection. Urine cultures are done to find bacteria and confirm a UTI.
This is the main test for bladder reflux. It involves placing a small tube called a catheter into your child’s urethra. The urethra is the duct that carries urine out of the body from the bladder. We fill the bladder with a special dye. We take X-rays while the dye is filling and while your child urinates.
This uses sound waves to create pictures of your child’s bladder and kidneys. The test can show how well the kidneys are growing. It also shows whether the ducts that carry urine from the kidneys to the bladder (the ureters) are wider than normal.
Treatments and research
Treatment tailored to your child’s needs
We grade the severity of bladder reflux on a scale of 1 to 5. Five is the most severe. The grade and your child’s age and symptoms guide decisions about treatment.
We use antibiotics to treat UTIs. Sometimes we prescribe the drugs for daily use to prevent infections. This lessens the risk for kidney scarring. We might continue to use these drugs until your child outgrows their condition. This often happens in children with lower-grade reflux.
If your child has low- to mid-grade bladder reflux, use of a special type of bulking agent may be an option. This involves injecting a gel-like material through the urethra, the tube that carries urine out of the body. We deliver the gel to the area near the opening of the ureter, the duct that carries urine from the kidneys to the bladder. It creates a valve-like mechanism to prevent urine from flowing backward. It is a minimally invasive treatment.
Surgery could be an option if:
Your child isn’t taking antibiotics like they should
Preventive antibiotics aren’t helping
The reflux is getting worse or failing to improve as your child ages
Your child’s kidneys aren’t working well or growing like they should
There are abnormalities in your child’s bladder or ureter
Surgical treatment is known as ureteral reimplantation. Surgeons access your child’s bladder by making a small incision in the abdomen. Then they reposition the ducts that carry urine from the kidney to the bladder by tunneling them under the bladder wall. This creates what is essentially a one-way valve. The valve keeps urine from moving back to the kidney.
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