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Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into the ureters and potentially the kidneys, occurring due to incompetence of the ureterovesical junction. This retrograde flow can lead to recurrent urinary tract infections and potential kidney damage if left untreated. VUR is most commonly diagnosed in children and is classified into five grades based on the extent of reflux visualized on imaging studies.
VUR occurs when the normal one-way valve mechanism at the ureterovesical junction fails to prevent retrograde urine flow during bladder filling or voiding. This can result from a congenitally short intravesical ureteral tunnel, abnormal ureteral insertion, or elevated bladder pressures that overwhelm the antireflux mechanism. The refluxed urine can carry bacteria from the bladder to the upper urinary tract, predisposing to pyelonephritis and progressive renal scarring.
Clinical suspicion for VUR should be high in children presenting with recurrent febrile urinary tract infections, especially pyelonephritis, or those with a family history of VUR. The diagnosis is confirmed through voiding cystourethrogram (VCUG) which demonstrates retrograde flow of contrast into the ureters during bladder filling or voiding. Management decisions depend on the grade of reflux, patient age, presence of breakthrough infections, and evidence of renal scarring, with options ranging from antibiotic prophylaxis to surgical intervention.