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Vesicoureteric reflux (VUR) is the retrograde flow of urine from the bladder into the ureters ± renal pelvis, typically due to an incompetent vesicoureteric junction (VUJ).

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https://youtu.be/sW0AbXLqFNY

• It is a common pediatric urologic condition and a key cause of recurrent urinary tract infections (UTIs) and renal scarring.

Epidemiology:

• Occurs in 1–2% of all children, but more common in those with febrile UTIs.
• Often familial (10–30% of siblings affected).
• Bilateral in ~50% of cases.

Etiology

Etiological classifiction:

| Primary VUR (common) | Congenital incompetence of the intravesical ureter | • Short submucosal tunnel • Abnormal insertion angle | | --- | --- | --- | | Secondary VUR | Due to increased intravesical pressure or outflow obstruction | • Posterior urethral valves (PUV) • Bladder dysfunction/neurogenic bladder • Urethral stricture • Post-inflammatory changes |

Anatomical basis:

![Anatomy of the urinary tract and implications for the pathogenesis of VUR: a, Normal ureterovesical junction with long submucosal tunnel and oblique entry into the bladder at the trigone. When the bladder fills, the intravesical pressure increases (arrows), compressing the intramural ureter, therefore preventing vesicoureteral reflux (VUR). b, An abnormally short tunnel length permits VUR as the intramural ureter is not long enough to be compressed by increasing pressure in the filling bladder (arrows).

Cooper, C. S. Diagnosis and management of vesicoureteral reflux in children. Nat. Rev. Urol. 6, 481–489 (2009). Puri, P., Friedmacher, F., Farrugia, MK. et al. Primary vesicoureteral reflux. Nat Rev Dis Primers 10, 75 (2024). https://doi.org/10.1038/s41572-024-00560-8](attachment:8e6cef0e-a7ce-4e19-8da8-4cc384f12c36:41572_2024_560_Fig1_HTML.webp)

Anatomy of the urinary tract and implications for the pathogenesis of VUR: a, Normal ureterovesical junction with long submucosal tunnel and oblique entry into the bladder at the trigone. When the bladder fills, the intravesical pressure increases (arrows), compressing the intramural ureter, therefore preventing vesicoureteral reflux (VUR). b, An abnormally short tunnel length permits VUR as the intramural ureter is not long enough to be compressed by increasing pressure in the filling bladder (arrows).

Cooper, C. S. Diagnosis and management of vesicoureteral reflux in children. Nat. Rev. Urol. 6, 481–489 (2009). Puri, P., Friedmacher, F., Farrugia, MK. et al. Primary vesicoureteral reflux. Nat Rev Dis Primers 10, 75 (2024). https://doi.org/10.1038/s41572-024-00560-8

Clinical Presentation

• Recurrent febrile UTIs
• Failure to thrive
• Newborns: Antenatal hydronephrosis
• Older children: Incontinence, flank pain, hypertension (due to scarring)