Congenital Urinary Disorder: Vesicoureteral reflux

Overview

What is vesicoureteral reflux (VUR)?

• Vesicoureteral reflux (VUR) is a condition in which urine flows backwards from the bladder (the organ that stores urine) into one or both urine tubes (ureters) and sometimes into the kidneys
• Normally, urine flows in one direction from the kidneys, through the urine tubes (ureters), into the bladder
• In VUR, the valve where the urine tube joins the bladder does not close properly, allowing urine to flow backwards
• Most children with VUR do not have long-term problems, especially with early diagnosis and treatment¹

Who is more likely to have VUR?

VUR is most common in babies and young children, especially those under 2 years of age. However, it can also occur in older children and, less commonly, in adults.

A child is more likely to have VUR if they:

• Have a family history of VUR, such as a parent, brother or sister with the condition
• Are born with abnormalities of the kidneys or urinary tract
• Have bladder or bowel problems that affect normal urination or bowel movements
• Are female, as VUR is more common in girls than boys

Signs and symptoms

Some children with VUR have no symptoms.

A child with VUR may have:

• Recurrent urinary tract infections (UTIs)
• Bladder or kidney infections
• Urinary incontinence (urine leakage)
• Bedwetting
• Difficulty emptying the bladder
• Constipation

If left untreated, VUR may lead to:

• Recurrent UTIs
• Permanent damage to the kidneys
• Reduced kidney function in severe cases

Causes of VUR

There are two main types of VUR:

• Primary VUR: Present at birth. The valve between the bladder and the urine tube (ureter) does not close properly, allowing urine to flow backwards. It often improves as the child grows¹
• Secondary VUR: Caused by a blockage or a bladder problem that prevents urine from flowing normally, causing it to flow back towards the kidneys¹

How is VUR diagnosed?

The doctor may recommend the following tests:

• Urine tests to check for a UTI
• Ultrasound scan to look at the kidneys and bladder
• Voiding cystourethrogram (VCUG), a special X-ray that checks if urine flows backwards from the bladder into the ureters and kidneys

What treatments are available for VUR?

Treatment depends on the child's age, symptoms and the severity of VUR.

Treatment options for VUR may include:

• Regular monitoring, as mild VUR often improves as a child grows
• Antibiotics to treat or help prevent UTIs
• Ureteric reimplantation surgery if VUR is severe or UTIs keep coming back
• Bulking injection treatment, where a gel is injected near the ureter opening to help prevent urine from flowing backwards. This is done under general anaesthesia, and most children go home the same day

Endoscopic injection treatment for vesicoureteral reflux

What is endoscopic injection treatment and why is it done?

• Endoscopic injection treatment is a minimally invasive procedure used to treat VUR
• A special gel is injected near the opening of the ureter inside the bladder
• The gel creates a small bulge that acts like a valve, helping to prevent urine from flowing backwards towards the kidneys
• It is commonly used in children with persistent or recurrent VUR

The procedure may be recommended if:

• UTIs keep coming back
• Antibiotics have not been effective
• VUR is not improving with age
• The kidneys are at risk of damage

What is the gel made of?

The gel contains dextranomer and hyaluronic acid, which are safely absorbed and gradually replaced by the body's own tissue over time.

Before the procedure

Before the procedure, the doctor will:

• Review your child's medical history and medicines.
• Explain the procedure and possible risks
• Advise when your child should stop eating and drinking
• Discuss the general anaesthetic

Procedure

Step-by-step overview

• Your child will be given medicine to make them sleep during the procedure
• A thin tube with a small camera (cystoscope) is passed through the urethra into the bladder
• The doctor examines the bladder using a tiny camera
• A small amount of gel is injected near the opening of the affected ureter.
• The gel helps stop urine from flowing backwards.
• The instruments are removed after the injection
• The procedure usually takes less than 30 minutes
• No external cuts are made

After the procedure

• Your child will be monitored until fully awake
• Mild discomfort or burning while passing urine may occur for a short time
• Most children go home the same day
• A follow-up scan or special X-ray may be arranged to check if the treatment has worked

Benefits and risks of endoscopic injection treatment

Benefits

• Minimally invasive with no external cuts
• Short procedure and recovery time
• Same-day discharge for most children
• Low risk of complications
• Helps reduce urine flowing backwards and lowers the risk of repeated UTIs

Possible risks

Like any procedure, endoscopic injection treatment has some risks, including:

• Bleeding or bruising
• Urinary tract infection
• Bladder injury
• Blockage of the ureter
• VUR may continue or return, and another injection or surgery may be needed.

Recovery

Most children:

• Go home on the same day.
• Can return to normal activities within a few days.
• May need follow-up appointments to check treatment results

What should I watch for after the procedure?

It is normal if your child:

• Has mild pain or burning while passing urine
• Has light pink urine
• Passes urine more often or has temporary urine leakage
• Is reluctant to pass urine for a short time

These symptoms usually improve within 1–2 days. Encourage your child to drink plenty of fluids and not hold their urine for long periods. Contact your doctor if these symptoms last longer or get worse.

When should I contact my doctor?

Contact your doctor if your child:

• Is unable to pass urine or has not passed urine for 8–10 hours
• Has pain while passing urine that lasts for more than 2 days
• Has severe pain in the stomach area, back or side
• Has a fever above 38.6°C
• Has bladder spasms that do not improve within 24 hours
• Has frequent vomiting
• Has back or hip pain

Myths and facts

Myth 1: All children with VUR need surgery. Fact: Many children with mild VUR improve as they grow and only need monitoring or antibiotics.

Myth 2: VUR always causes symptoms. Fact: Some children with VUR have no symptoms and are diagnosed after a urinary tract infection (UTI).

Myth 3: Endoscopic injection treatment is an open operation. Fact: It is a minimally invasive procedure performed through the urethra, with no external cuts.

Myth 4: One injection always cures VUR. Fact: Some children may need another injection or surgery if VUR continues or returns.

Myth 5: Recovery after endoscopic injection treatment takes a long time. Fact: Most children go home the same day and return to normal activities within a few days.

References

1. National Institute of Diabetes and Digestive and Kidney Diseases. Vesicouteral reflux. (VUR) [Online] Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/hydronephrosis-newborns/vesicoureteral-reflux. Accessed on: 15 July 2026.
2. Cleveland Clinic. Vesicouteral reflux. [Online] Available from: https://my.clevelandclinic.org/health/diseases/5995-vesicoureteral-reflux. Accessed on: 15 July 2026.
3. Cleveland Clinic. Deflux: Treatment for Vesicoureteral Reflux

[Online] Available from: https://my.clevelandclinic.org/health/treatments/16320-deflux-treatment-for-vesicoureteral-reflux. Accessed on: 15 July 2026.