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Vesicoureteral reflux

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What is vesicoureteral reflux?

Urine is produced in the kidneys. It travels from the kidneys to the bladder through tubes called ureters. Once the urine enters the bladder, it should remain there until voiding (emptying the bladder) takes place. 

Vesicoureteral reflux (ves-i-ko-you-ree-ter-al  ree-fluks) is the name of a condition in which urine backs up from the bladder into the ureter toward the kidney. This can involve one or both ureters.

The ureters enter the bladder at an angle, forming a tunnel which acts as a valve mechanism. If the tunnel through the bladder wall is too short, reflux of urine occurs. As your child grows, the length of the tunnel will grow. Most of the time this growth solves the reflux problem.

Is reflux serious?

Most urinary tract infections stay in the bladder. With reflux, however, bacteria can get into the kidneys and cause a kidney infection called pyelonephritis. This can cause damage to the kidneys, which is very serious.

Reflux is graded on a scale of one through five. Grade I flows part way up the ureter. Grades II through V flow all the way up the ureter and into the kidney. With higher grades the shape of the ureter changes.


What tests will my child have?

Your provider will determine if one or more of the following tests need to be done to determine your c hild's grade of reflux.  This sheet briefly explains each test.  More information is available if a test is scheduled.

Depending on their age, brothers and sisters of children with vesicoureteral reflux may have an increased risk for reflux.  Your provider will decide if the siblings need any tests.

Voiding cystourethrogram (VCUG)

This test is done in the radiology (X-ray) department.  A catheter (small tube) is inserted into the bladder through the urethra.  Contrast fluid is given through the catheter and X-ray pictures are taken.  When the bladder is filled, your child will urinate, and more pictures will be taken of the bladder, ureters, and kidneys. See the education sheet,”Voiding Cystourethrogram for Boys or Voiding Cystourethrogram for Girls”.

Renal ultrasound

This test is done to look at the kidneys, ureters, and bladder to detect any problems.  No catheters or needles are used.  A technician will move a transducer (looks like a small microphone) across your child’s abdomen.  The transducer produces ultra-high frequency sound waves which pass painlessly and harmlessly through the lower abdomen, bouncing off the kidney and bladder.  The sound that bounces off the kidney and bladder returns to the transducer with information.  A picture of this information is displayed on a lighted screen for the technician to watch.

Radionuclide cystogram (RNC)

This test uses nuclear medicine equipment that delivers a much lower dose of radiation than traditional X-rays.  It is usually a follow-up test, done sometime after the first VCUG.  Like the VCUG, it involves a small catheter that is inserted into the bladder. See the education sheet,” Radionuclide Cystogram (RNC)”.

Renal scan

This scan shows how much each kidney is functioning and any scarring of the kidneys from the reflux.  Depending on the type of renal scan, a catheter may be needed.  An IV is used for the test. See the education sheet,” Renal Scan or DMSA)”.

What is the treatment?

Your provider will discuss which options are best for your child.


This is not specific to your child, but provides general information. If you have any questions, please call your health care professional.

Reviewed 4/2018

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