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Adolescent Urology
Vesicoureteral Reflux (VUR)
Vesicoureteral reflux is the abnormal backflow of urine from the bladder up to the kidneys. Specialist adolescent and adult care focuses on protecting kidney function, preventing infections, and managing the long-term consequences of childhood VUR.
Clinically reviewed by
Mr Anthony Noah
Consultant Urological Surgeon · Reviewed August 2026 · Review due August 2027
What is Vesicoureteral Reflux?
Vesicoureteral reflux (VUR) is the abnormal backflow of urine from the bladder up the ureters towards the kidneys. Normally, a one-way valve mechanism where each ureter enters the bladder allows urine to flow in only one direction, from the kidneys down into the bladder. When this valve does not function correctly, urine can travel backwards up the ureter and reach the kidney, particularly when the bladder is full or during urination.
VUR is most commonly diagnosed in childhood, but can also begin in adulthood. It may be associated with pain, urinary tract infections or be asymptomatic. Many milder cases resolve spontaneously as a child grows and the ureteric tunnel through the bladder wall lengthens. However, in some cases, adolescents and adults can be left with important long-term consequences, including reflux nephropathy (kidney scarring and damage), recurrent urinary tract infections, hypertension, and reduced kidney function.
At London Urology Specialists, our adolescent urology service provides expert transitional and adult care for young people and adults with a history of VUR. Mr Anthony Noah leads the adolescent service, with a particular focus on protecting long-term kidney health, managing recurrent infections, and supporting young women planning pregnancy.
Childhood VUR can have lifelong consequences
Even after VUR appears to resolve, reflux nephropathy and renal scarring from childhood can lead to hypertension and chronic kidney disease in adulthood. A specialist adult review is particularly important if you have recurrent UTIs, raised blood pressure, or are planning pregnancy.
Why Adolescent and Adult Care Matters
VUR is too often thought of as a purely paediatric condition. In reality, the children who have it grow into adolescents and adults who can carry the consequences with them for life. Specialist transitional and adult review focuses on the following:
Reflux Nephropathy
Renal scarring and damage caused by childhood VUR can progress silently over decades. It is a leading cause of hypertension and chronic kidney disease in young adults and needs proactive surveillance long after childhood.
Persistent or Untreated Reflux
Many patients with mild childhood VUR are managed without surgery on the expectation that reflux would resolve. In some, low-grade reflux persists into adolescence and adulthood and, therefore, monitoring until adulthood of these patients is vital.
Pregnancy & Reflux Nephropathy
Pregnancy significantly increases the risk of UTI and pyelonephritis in women with VUR. Reflux nephropathy is also associated with pregnancy-induced hypertension and pre-eclampsia, so pre-pregnancy planning is important.
Late-Onset Hypertension
Unexplained high blood pressure in adolescents and young adults can sometimes be traced back to childhood VUR and renal scarring. Identifying this cause early allows targeted treatment and protection of remaining kidney function.
Recurrent UTIs in Adolescence
Recurrent urinary tract infections in adolescence, particularly pyelonephritis with fevers and loin pain, may indicate persistent or secondary VUR and warrants specialist imaging.
Coexisting Bladder Dysfunction
Many adolescents and adults with persistent VUR have associated bladder dysfunction — overactive bladder, dysfunctional voiding, or incomplete emptying. Addressing this is essential to treating the reflux successfully.
Grades of Vesicoureteral Reflux
VUR is classified into five grades according to the International Reflux Study system, based on how far urine refluxes back up the ureter and how much it dilates the ureter and kidney. The grading at childhood is helpful background, but reflux can change over time — what matters most is your current assessment.
Grade I — Reflux into Ureter Only
Urine refluxes only into the ureter and does not reach the kidney. The ureter is not dilated. Grade I reflux often resolves spontaneously and rarely requires intervention.
Grade II — Reflux to the Kidney without Dilatation
Urine refluxes up to the renal pelvis and calyces, but neither the ureter, pelvis, nor calyces are dilated. Often managed conservatively with monitoring and UTI prevention.
Grade III — Mild Dilatation
Reflux reaches the kidney with mild dilatation of the ureter, renal pelvis, and calyces, but the calyces still have a normal cup-shape. Treatment is individualised; some cases resolve, others require intervention.
Grade IV — Moderate Dilatation
Moderate dilatation and tortuosity of the ureter, with moderate dilatation of the renal pelvis and calyces. The calyces are blunted, but most papillary impressions are maintained. Higher risk of scarring and recurrent infection.
Grade V — Severe Dilatation with Intrarenal Reflux
Gross dilatation and tortuosity of the ureter, marked dilatation of the renal pelvis and calyces, loss of papillary impressions, and intrarenal reflux. Grade V reflux carries the highest risk of pyelonephritis, scarring, and progressive kidney damage, and usually requires surgical correction.
Symptoms in Adolescents and Adults
VUR in adolescents and adults can be completely silent. Symptoms, when present, are often related to infection or kidney injury and may include:
Recurrent Urinary Tract Infections
Particularly upper tract infections (pyelonephritis) with high fevers, flank pain, and rigors. Recurrent UTIs in young adults, especially with kidney involvement, should prompt assessment for reflux.
Flank Pain During Voiding
Pain in the loin during or just after passing urine, caused by the bladder pressure being transmitted up the refluxing ureter to the kidney. This can be a classic symptom of significant reflux.
Loin Pain with UTI
UTIs in patients with reflux are more likely to be associated with loin pain, suggesting kidney involvement. This is an important reason to seek prompt assessment of recurrent infections.
Hypertension
Raised blood pressure may be the first sign that childhood VUR has caused renal scarring. Young adults found to be hypertensive at routine checks should have their kidneys assessed.
Reduced Kidney Function
Abnormal kidney function picked up on routine blood tests (raised creatinine or protein in the urine) may be the only sign of silent reflux nephropathy.
UTI in Pregnancy
Women with a history of VUR are at higher risk of urinary tract infection during pregnancy. A UTI in early pregnancy in a woman with childhood VUR should trigger a specialist review of her urinary tract.
VUR can be completely silent
Many adults with reflux nephropathy have no symptoms until kidney function or blood pressure is found to be abnormal. If you had VUR as a child, it is worth having a review as an adult to check on kidney function and imaging.
Assessment & Investigations
Specialist assessment combines a careful history with focused investigations to define current reflux, kidney function, and any associated bladder dysfunction. At London Urology Specialists we offer:
Detailed History
A thorough history including childhood VUR diagnosis, treatments received (surveillance, antibiotics, surgery), previous UTIs and admissions, family history, and current urinary, blood pressure, and pregnancy concerns.
Blood Pressure & Renal Function
Blood pressure measurement, serum creatinine, eGFR, electrolytes, and a urine protein:creatinine ratio. These simple baseline tests are central to detecting reflux nephropathy early.
Urinalysis & Urine Culture
Dipstick analysis and mid-stream urine culture identify any current infection, asymptomatic bacteriuria, and proteinuria. Culture and sensitivities also guide antibiotic choices for any future infections.
Renal Tract Ultrasound
A non-invasive scan of the kidneys, ureters, and bladder. It provides a quick assessment of kidney size, scarring, hydronephrosis, ureteric dilatation, post-void bladder residual, and any anatomical abnormality.
MAG3 or DMSA Renal Scan
Nuclear medicine scans that assess kidney function and scarring in detail. DMSA shows differential function and renal scarring; MAG3 dynamic scans assess drainage and function and are particularly useful when obstruction or impaired drainage is suspected.
Voiding Cystourethrogram (VCUG)
The gold-standard investigation for diagnosing and grading vesicoureteral reflux. A small catheter is used to fill the bladder with contrast, and X-ray images are taken during voiding to show whether and how far urine refluxes up the ureters.
Cystoscopy
In selected cases, a flexible camera examination of the bladder allows direct assessment of the ureteric openings and bladder lining. Cystoscopy is also used to plan and perform endoscopic injection treatments.
Video Urodynamics
Pressure-flow studies are arranged where associated bladder dysfunction is suspected such as overactive bladder, dyssynergic voiding, or incomplete emptying. In some cases, video urodynamics are preferred over VCUG. Treating bladder dysfunction is critical to long-term success in managing reflux.
Treatments We Offer at LUS
Treatment is highly individualised, based on the current grade of reflux, kidney function, infection burden, bladder function, and your future plans (such as pregnancy). The following treatments are delivered directly by our specialist team:
Surveillance for Low-Grade VUR
Non-SurgicalFor adolescents and adults with low-grade VUR and stable kidney function, structured surveillance is often the right approach. We monitor blood pressure, kidney function, urine culture, and renal imaging on an agreed schedule. Most patients can be managed without surgery, with prompt treatment of any infection.
UTI Prevention Strategies
ConservativeTargeted UTI prevention, including hydration advice, voiding habits, post-coital prophylaxis, vaginal oestrogen where appropriate, and low-dose prophylactic antibiotics in selected cases — significantly reduces infection burden and helps protect the kidneys.
Treatment of Bladder Dysfunction
Often CoexistingBladder dysfunction is common in patients with persistent reflux and, untreated, may keep the reflux going. We address overactive bladder, voiding dysfunction, and incomplete emptying with bladder training, medication, pelvic floor therapy, and intermittent self-catheterisation as needed.
Blood Pressure Monitoring & Management
Kidney ProtectionTight blood pressure control is the single most important intervention for protecting kidney function in reflux nephropathy. We work with your nephrologist to optimise antihypertensive treatment, often with ACE inhibitors or angiotensin receptor blockers as first-line agents.
Pregnancy Planning Advice
Pre-PregnancyFor women planning pregnancy, we offer focused pre-pregnancy counselling: baseline kidney function and imaging review, optimisation of blood pressure medication alongside your nephrologist and obstetrician (it is important to stop ACE inhibitors before conception), UTI prevention strategies, and shared care planning with an obstetric team.
Endoscopic Injection of Bulking Agent
Minimally InvasiveA day-case procedure performed through a cystoscope, in which a small volume of bulking agent is injected just below the refluxing ureteric opening. The injection narrows the opening and reinforces the valve mechanism, reducing or eliminating reflux. Suitable for selected adolescents and adults with persistent low or moderate-grade reflux.
Surgical Ureteric Reimplantation
Severe / Symptomatic CasesFor high-grade, recurrent, or severely symptomatic reflux not controlled by other measures, the ureter is surgically reimplanted into the bladder to create a long submucosal tunnel that acts as a competent one-way valve. Key principles include:
- ›Adequate tunnel length — to create a competent valve mechanism
- ›Preservation of ureteric blood supply — to ensure healthy long-term function
- ›Concurrent bladder dysfunction management — to protect the new anastomosis
- ›Post-operative imaging — to confirm resolution of reflux and good drainage
A long-term, kidney-focused plan
The goal of adolescent and adult VUR care is not just to treat current symptoms, but to protect kidney function for decades to come. Every treatment plan is individualised and reviewed regularly.
Other Treatments
A small number of treatments for advanced reflux nephropathy fall outside the scope of our adolescent urology service. Where appropriate, we coordinate referral to specialist colleagues:
Renal Replacement Therapy
Nephrology ReferralIf reflux nephropathy progresses to advanced chronic kidney disease, dialysis or other forms of renal replacement therapy are managed by specialist nephrology teams. We work closely with our nephrology colleagues to ensure seamless care.
Renal Transplantation
Transplant Centre ReferralFor patients reaching end-stage renal failure from reflux nephropathy, kidney transplantation provides the best long-term outcome. We refer to specialist transplant teams and remain involved in the urological aspects of care.
Complex Paediatric Reconstruction
Paediatric ReferralFor younger adolescents who still require complex paediatric reconstructive surgery — such as ureteric reimplantation in the setting of a paediatric neuropathic bladder — we refer to specialist paediatric urology centres for ongoing surgical care.
What to Expect at Your Appointment
Your first appointment is unhurried and patient-centred. The focus is on understanding your childhood VUR history, examining you carefully, and setting up the right baseline tests and long-term plan.
Detailed Childhood VUR History
We will ask about how and when your VUR was diagnosed, what treatments you had (antibiotics, surgery, follow-up), and how it has affected you since. Old hospital letters and scan results are very helpful — please bring them if available.
Examination & Baseline Tests
A focused examination including blood pressure measurement. We will arrange baseline blood tests for kidney function, urinalysis and urine culture, and renal tract imaging as appropriate.
Discussion & Plan
We discuss what your test results show, your individual risk of long-term complications, and the options available to you. Time is always made to talk through pregnancy plans and family planning concerns.
Long-Term Surveillance
We agree a long-term surveillance schedule — typically annual review of blood pressure and kidney function, with imaging at agreed intervals — so that any change can be detected and acted on early.
Please bring old hospital records
Childhood imaging reports, surgical notes, and old clinic letters help us understand exactly what you had and avoid duplicate tests. If you do not have copies, we can usually request them on your behalf.
Meet your Specialists
Assessment and treatment of adolescent and adult vesicoureteral reflux (VUR) is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists.
Key Takeaways
If you had vesicoureteral reflux as a child, an adult specialist review is worthwhile — particularly if you have recurrent UTIs, raised blood pressure, or are planning pregnancy. With baseline kidney function tests, focused imaging, and long-term surveillance, the great majority of patients can be reassured and kept well, with effective treatment available for those who need more than monitoring.
Frequently Asked Questions
Vesicoureteral reflux (VUR) is the abnormal backflow of urine from the bladder up the ureters towards the kidneys. Usually, a one-way valve mechanism at the junction of the ureter and bladder prevents this. When the valve does not function properly, urine can travel back up to the kidneys, increasing the risk of kidney infection, kidney scarring (reflux nephropathy), high blood pressure, and reduced kidney function over time.
Yes. The most important of these is reflux nephropathy (kidney scarring and damage caused by childhood infections and reflux), which can lead to high blood pressure, reduced kidney function, and pregnancy complications later in life. Some adults also have persistent low-grade reflux that was never operated on. A specialist adult review of childhood VUR is worthwhile, particularly if you have hypertension, recurrent UTIs, or are planning pregnancy.
Patients can be risk stratified depending upon whether or not they have ongoing VUR and whether they have developed any consequences of the VUR. Our specialists are able to advise whether long-term follow-up is required. This typically includes annual blood pressure checks, periodic blood tests of kidney function (eGFR and creatinine), urinalysis, and occasional renal imaging. The aim is to detect any worsening kidney function or developing hypertension early, when it is most easily treated.
Yes. Many adults with mild VUR and stable kidney function can be managed with surveillance, UTI prevention, and blood pressure control. For symptomatic adults, particularly those with recurrent pyelonephritis or progressive kidney damage, treatment options include endoscopic injection of a bulking agent at the ureteric opening (a minimally invasive day-case procedure) and, in selected severe cases, surgical ureteric reimplantation to recreate a competent valve.
Pregnancy increases the risk of urinary tract infection in all women, and the risk is significantly higher in women with VUR or reflux nephropathy. Untreated UTIs in pregnancy can progress to pyelonephritis, which can complicate the pregnancy. Women with reflux nephropathy also have a higher risk of pregnancy-related hypertension and pre-eclampsia. Pre-pregnancy counselling, careful UTI surveillance, and shared care with an obstetrician are strongly recommended.
Continue Your Care with Confidence
If you have a history of childhood vesicoureteral reflux (VUR), our experienced consultant urologists provide specialist assessment and ongoing care for adolescents and adults, with personalised management to support your long-term urological health.