Gerald R. Jerkins MD
Pediatric Urology Associates
of the MidSouth, P.C.
Memphis Tennessee

Reflux

The backflow of urine from the bladder to the kidney [reflux] is not uncommon in children who have urinary tract infections. In fact, 20-40% of children with urinary tract infection, will have reflux. It can also be seen in boys who are born with an obstruction to the outflow of the bladder, as well as in children with neurogenic bladder.

Reflux is a congenital problem, and most of the time is not associated with other physical abnormalities. It occurs because the connection between the ureter and the bladder is abnormal and allows urine from the bladder to flow back toward the kidney. Normally [figure 1] the ureter enters the bladder through a tunnel between the bladder lining [mucosa] and the wall of the bladder [bladder muscle].This connection acts like a one way valve and prevents the flow of urine back to the kidney.

Reflux can occur when the ureter enters the bladder through a very short tunnel.[figure 2] When this happens, the connection between the ureter and the bladder loses its one way valve effect and allows the urine to flow back up the ureter to the kidney. Infected urine that refluxes can cause damage to the kidney.

The goal of treating reflux is to prevent kidney damage. Reflux will resolve about 80% of the time. However it is important that once the reflux is identified that every effort is made to keep the urine infection free. This will usually require low dose daily antibiotics until the reflux either resolves or is corrected surgically. Once the reflux is no longer present, the antibiotic can usually be stopped.

Reflux has 5 categories or grades.[ figure 3] Grade I reflux is the least and grade V is the most severe. The grades have a reasonable correlation with the likelihood that the reflux will resolve with the growth of the child. Children with grade I have about a 90% chance of the reflux going away, while those with grade V have 20% or less likelihood of improvement. Knowing the grade of reflux can be helpful is deciding the type of treatment for the child with reflux.

Options for treatment of reflux include, low dose daily antibiotics with interval bladder x-rays to follow the status of the reflux. In some children it may take 2 years or longer for them to outgrow the reflux. Surgical correction may be considered in some children that have progression of reflux or have infection in spite of the daily antibiotics.

Treatment of the child with reflux is based on many factors, and is not limited to those mentioned here in this brief discussion. This information and the links listed may provide you with useful information so that you will be familiar with some of the facts about reflux before you talk with your family doctor or Dr Jerkins.

For an appointment with Dr Jerkins please call 751-0500 [in the Memphis area] or 1-877-751-0500 [toll free number].

Helpful Links

http://www.urologychannel.com/pediatric/vur_treatment.shtml
http://kidney.niddk.nih.gov/Kudiseases/pubs/vesicoureteralreflux/