History
Vesicoureteral reflux (VUR) may be suspected in the prenatal period, when transient dilatation of the upper urinary tract is noted in conjunction with bladder emptying. Approximately 10% of neonates diagnosed prenatally with dilatation of the upper urinary tract will be found to have reflux postnatally. It should be noted that VUR cannot be diagnosed prenatally.
In general, VUR does not cause any specific signs or symptoms unless complicated by urinary tract infection (UTI). In other words, VUR is almost always asymptomatic unless it has led to a kidney infection (febrile UTI). Clinical signs and symptoms associated with a febrile UTI in a neonate may include irritability, persistent high fever, and listlessness. In cases of VUR and febrile UTI associated with a serious underlying urinary tract abnormality, the neonate could present with respiratory distress, failure to thrive, renal failure, flank masses, and urinary ascites.
Older children may more clearly communicate signs and symptoms associated with a UTI (eg, urgency, frequency, dysuria, incontinence), but unless the UTI is associated with a fever, there is little reason to suspect VUR.
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A voiding cystourethrogram (VCUG) of a patient with grade III vesicoureteral reflux (VUR). Note that the contrast flows up the ureter and into the renal pelvis. The calyces are sharp, and no evidence of hydronephrosis exists.
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This is an example of grade V vesicoureteral reflux (VUR). Note the dilated renal pelvis and calyces. The ureter also is dilated and tortuous.
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This is bilateral vesicoureteral reflux (VUR) with paraurethral (Hutch) diverticulum.
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Vesicoureteral reflux (VUR). Nuclear cystogram showing reflux of radioisotope into left collecting system.
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A dimercaptosuccinic acid (DMSA) scan in vesicoureteral reflux (VUR). Photopenic areas of the left kidney indicate renal scarring.
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View of a ureteral orifice before and after endoscopic treatment.
