Epidemiology

Age: children < 2 years

Etiology

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

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

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

Tip

VUR is generally asymptomatic until it causes a urinary tract infection.

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