Epidemiology

Age: children < 2 years

Etiology

Primary VUR (most common type)

Short intramural ureter → vesicoureteric junction (VUJ) fails to close completely during bladder contraction → VUR

Secondary VUR

• Bladder outlet obstruction (anatomic/functional): high pressure within the bladder → reflux of urine through the VUJ
• Anatomic: posterior urethral valves ; urethral meatal stenosis

Pathophysiology

Clinical features

• Suspected in the prenatal period when hydronephrosis is detected on routine antenatal ultrasound
• Postnatal presentation
  • Recurrent febrile urinary tract infections
    • Neonates: irritability, fever, and listlessness
    • Older children: urinary urgency, frequency, incontinence, and dysuria associated with fever
  • Reflux nephropathy : renovascular hypertension, kidney failure, uremia

Diagnostics

Treatment

Spontaneous resolution occurs in most patients with mild VUR, because the intravesical ureter length increases with patient growth.