What is vesicoureteral reflux (VUR)?
Each kidney drains urine down a tube called the ureter into the bladder. Normally the ureter passes through a short tunnel in the bladder wall, which acts like a flap valve: when the bladder fills or squeezes, the tunnel closes and urine cannot go back up.
In vesicoureteral reflux (VUR), this tunnel is too short, so urine flows back up towards the kidney. Reflux itself does not hurt. The problem is that germs in the bladder can reach the kidney and cause a kidney infection with fever, which can leave scars.
Primary reflux is present from birth. Secondary reflux is caused by high bladder pressure, as with posterior urethral valves or a nerve problem of the bladder. Reflux often runs in families.
Grades of reflux I to V, in plain words
Reflux is graded on the MCU X-ray from I (mildest) to V (most severe).
| Grade | What it means | Usual outlook |
|---|---|---|
| I | Urine goes back into the ureter only | Often settles with growth |
| II | Urine reaches the kidney, with no swelling | Often settles with growth |
| III | Mild to moderate widening of the ureter and kidney | May settle; watched closely |
| IV | Moderate swelling; the kidney’s drainage cups lose their shape | Less likely to settle; higher risk of scarring |
| V | Severe swelling; the ureter is wide and twisted | Rarely settles; surgery more often needed |
Which children need tests for reflux?
Tests for reflux are usually advised for:
- A baby or young child with a urine infection with fever, especially a second one, or when the ultrasound is abnormal
- A baby with a swollen kidney on a pregnancy scan that is still present after birth (see hydronephrosis)
- A child whose kidney scan shows scarring
- Sometimes, a brother or sister of a child with reflux
Older children with reflux often also have daytime wetting, holding of urine or constipation, which are looked for at the visit.
Tests: ultrasound, MCU and DMSA scan
- Ultrasound of the kidneys and bladder, to look at size, swelling and the bladder wall.
- MCU (micturating cystourethrogram): a fine catheter is passed into the bladder, dye is run in, and X-rays are taken while the bladder fills and while the child passes urine. It shows whether there is reflux and its grade. It is done when there is no active infection. It is uncomfortable for a short time, and a parent can usually stay.
- DMSA scan: a small amount of tracer is injected into a vein and pictures are taken a few hours later. It shows scars and how much work each kidney does. It is usually done some months after an infection, to see lasting scars.
- Urine culture with every fever, taken before antibiotics start, so infections are confirmed and treated correctly.
Treatment without surgery: watching, antibiotics and bladder habits
Many children, especially with grades I-III, are managed without an operation:
- Watchful waiting with antibiotic prophylaxis: a small daily dose of an antibiotic, often at bedtime, to prevent infections while the child grows. It is used mainly for infants and higher grades; not every child needs it.
- Treating constipation: more water, fibre and fruit, and medicine if needed. A full bowel presses on the bladder and makes infections more likely.
- Good bladder habits: passing urine every 2-3 hours by day, sitting relaxed with feet supported, and not holding urine.
- Quick action with fever: any fever without a clear cause needs a urine test the same day.
The ultrasound, and sometimes the MCU, is repeated after one to two years. As the child grows, the tunnel in the bladder wall gets longer, and many low-grade cases improve or stop.
When does a child need VUR surgery, and how is it done?
Surgery is considered when:
- Infections with fever keep happening despite antibiotics
- New kidney scars appear
- High-grade reflux continues as the child grows
- Long-term antibiotics are not possible
The operation Dr. Negi performs is ureteric reimplantation. Under general anaesthesia, the ureter is detached from the bladder and re-joined through a longer tunnel under the bladder lining, so it works as a valve again. It is usually done through a small, low cut in the bikini line, or by laparoscopy in selected children, and takes about 2-3 hours. A catheter, and sometimes a small stent (a soft inner tube in the ureter), is left in. Surgery is done at ManglamPlus Medicity with fine open or child-sized laparoscopic instruments.
Endoscopic injection of a bulking gel at the ureter opening, through a cystoscope, is another option used in some centres for selected children. Where it is suitable, it can be arranged with the right specialist.
Hospital stay and recovery after reflux surgery
| When | What usually happens |
|---|---|
| Day of surgery | Pain relief, drip fluids, feeding once awake |
| Days 1-3 | Catheter removed; bladder spasms and some blood in the urine are common |
| Days 2-4 | Home when comfortable and passing urine |
| Weeks 2-4 | Back to school; stent removed in a short procedure if one was placed |
| Months 1-3 | Ultrasound to check the kidney drains well |
Call the clinic if: your child has a fever, vomits repeatedly, has severe tummy pain, cannot pass urine, or has heavy bleeding in the urine.
Risks, comparison of options and long-term follow-up
| Option | Usually suits | Things to know |
|---|---|---|
| Watching with good habits | Low grades, older children without infections | Needs quick urine tests with any fever |
| Antibiotic prophylaxis | Infants, higher grades, repeated infections | Daily medicine; some infections still break through |
| Ureteric reimplantation | Breakthrough infections, new scars, high grades | An operation with a short hospital stay |
| Endoscopic injection | Selected children, in some centres | Shorter procedure; may need repeating |
Risks of reimplantation include bladder spasms, blood in the urine, urine infection, reflux that remains, and, rarely, a blockage at the new join that may need a stent or a further operation.
Children with kidney scars need checks of blood pressure and urine protein over the years. Girls with scarring should tell their obstetrician about it in a future pregnancy. See the pediatric urology page for other children’s conditions.
Cost of vesicoureteral reflux treatment in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- The tests needed, such as MCU, DMSA scan, ultrasound and urine cultures
- Whether treatment is monitoring and medicines, or an operation
- Open or laparoscopic reimplantation, one or both sides
- Whether a stent is placed and needs a short procedure to remove
- The number of nights at ManglamPlus Medicity and the room category
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Vesicoureteral reflux treatment with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
Will my child outgrow reflux?
Many children with low-grade reflux improve or stop refluxing as they grow, because the tunnel in the bladder wall lengthens. Higher grades are less likely to settle on their own.
Is it safe to give a daily antibiotic for months?
Low-dose prophylaxis is widely used in children and is generally well tolerated. The doctor reviews regularly whether it is still needed, to avoid using it longer than necessary.
Does reflux damage the kidneys?
Reflux on its own does not usually harm the kidney. Damage comes from kidney infections with fever, which is why preventing and quickly treating infections matters.
Is the MCU test painful?
Passing the fine catheter is uncomfortable for a short time, but the test itself is not painful. A parent can usually stay, and the child goes home the same day.
Should brothers and sisters be tested?
Reflux runs in families, so the doctor may suggest an ultrasound for siblings, especially young ones or those who have had a urine infection with fever.
Can reflux come back after surgery?
Reimplantation stops the reflux in most children. Occasionally some reflux remains, and this is checked with an ultrasound or MCU after surgery if needed.
Is VUR surgery covered by insurance or schemes?
It depends on the policy and the hospital’s empanelment. Please confirm with the ManglamPlus Medicity billing desk and see payment, insurance and schemes.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.