Ureter

Vesicoureteral Reflux

Normally the kidneys make urine which drains down into the bladder by way of the ureter.  The ureter is implanted in 3 muscle layers in the bladder so that when a person urinates, those three muscles clamp down on the ureter to close off that opening.  This is so that when the bladder squeezes the urine, it only goes out by way of the urethra and not back up the ureter. If a ureter is not implanted properly, those muscles are not able to clamp down and close off that opening.  If this is the case, when the bladder squeezes to urinate, urine may then shoot back up the ureter into the kidney.  This is called vesico (bladder)-ureteral(ureter) reflux(going back up).

The bladder holds urine which frequently has bacteria in it.  Normally as long as we flush this bacteria out frequently an infection does not form.  When a patient has vesico-ureteral reflux, that bacteria repeatedly gets sent up to the kidney and can then cause a urinary tract infection with or without fever.

If a patient has urine in the kidney and/or ureter, or has a UTI with a fever,  a VCUG may be needed to determine whether this is due to vesico-ureteral reflux.  This test involves placing a catheter into the patient’s urethra and shooting dye into the bladder.  The technician then takes pictures of the bladder while the patient fills with contrast and then urinates to see whether that contrast goes up into the ureter and kidney.  If the contrast is seen going up into the ureter, it is confirmed the patient has vesico-ureteral reflux.

If reflux is found in an infant, normally we place the patient on a low dose antibiotic every day to keep the urine sterile. This is so that while the urine will still go back up to the ureter, it will be sterile and decrease the chance of urinary tract infections.  Surgery is not done immediately because vesico-ureteral reflux can go away with time. As long as we prevent infections from occurring we can prevent damage from occurring to the kidney.  

Should a patient continue to have urinary tract infections while on a low dose antibiotic, we will discuss surgical intervention to correct the reflux.