Vesicoureteral Reflux

Vesicoureteral Reflux

Signs and Symptoms
Diagnosis
Treatment

Diagnosis

Reflux usually is diagnosed in one of two ways.

• Children who have a urinary tract infection, which has been confirmed by a lab test, have a contrast X-ray evaluation called a voiding cystourethrogram. This study gives important information regarding the shape and size of the bladder, the bladder neck or opening, the urethra and the tubes or ureters that drain the urine from the kidneys into the bladder. If reflux is present, contrast material instilled into the bladder will backflow into the ureter and kidneys.

• Ultrasound during pregnancy may reveal a fetus with dilated kidneys. If this occurs, a VCUG is done soon after the birth of the baby.

It is especially important to diagnose and treat reflux in infants and small children since most of them will develop another urinary tract infection. Waiting until a child has had two or more urinary tract infections before having an evaluation increases the risk of permanent kidney damage or scarring.

Other tests may include:

• Kidney and Bladder Sonogram -- Otherwise known as "jelly-on-the-belly, this test is routinely recommended prior to the VCUG. The sonogram test, also called an ultrasound, is done to outline the kidneys, ureters and bladder. It also looks for less common urinary tract defects that can cause infections or kidney dilation. The test doesn't require radiation and is painless.

• Kidney (Renal) Scan -- This test may be done if the above tests are abnormal or if repeated fever-causing infections have occurred. It shows the actual function and drainage of the kidneys. A kidney scan also can show if there is kidney damage or scarring from a previous urinary tract infection.

• Nuclear Cystogram -- This test is very similar to the VCUG; however, it has less radiation and is very sensitive for reflux. The VCUG is the preferred initial test for diagnosing reflux because it provides a clearer picture of the lower urinary tract and therefore can rule out other less common abnormalities, as well as grade the reflux for severity. The nuclear cystogram, however, is the recommended test for subsequent follow-up to treat reflux after the diagnosis has been made by the VCUG. The nuclear cystogram also is used as a screening test for siblings of kids who have reflux.

Reflux is graded on a scale of one to five, with one being a mild form and five being severe, as determined by the VCUG. The degree of reflux determines how to treat the child. More severe grades are less likely to clear up spontaneously and have a higher incidence of renal damage if not treated.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007