Vesicoureteral Reflux (VUR) • By age and special situations

VUR in Adolescents and Adults: Follow-up, Treatment Decisions, and Pregnancy

Name: VUR in Adolescents and Adults: Follow-up and Pregnancy
Creator: Prof. Dr. Ali Avanoğlu
Published: 2026-08-19

Vesicoureteral reflux (VUR) that carries into adolescence and adulthood is most often low-grade and silent; but follow-up does not end here — it changes form. On this page we explain reflux that has not closed by adolescence, VUR in adults, and what infection–hypertension risk in pregnancy actually depends on.

Who this is forTeenagers whose reflux is still present in adolescence, adults with a childhood history of reflux or kidney scarring, and women planning pregnancy

Reading≈7 min

ByProf. Dr. Ali AvanoğluUpdated19 August 2026

This page is part of vesicoureteral reflux.Read the full treatment overview on the hub page

follow-up: first 3 months · first year · childhood · adolescent and adult

01 · Reflux that has not closed in adolescence: how much does it matter?02 · Treatment decisions in adolescents: surveillance, injection, surgery 03 · Vesicoureteral reflux in adults 04 · Vesicoureteral reflux in pregnancy: what does the risk actually depend on?05 · How does follow-up work before and during pregnancy?

In brief5 madde

Reflux that has not closed in adolescence: how much does it matter?: In a child who has reached adolescence, the chance of reflux closing on its own is now low; but at the same time, the chance of reflux damaging the kidney has also…
Treatment decisions in adolescents: surveillance, injection, surgery: Unlike in childhood, the goal of reflux treatment in adolescents is not to “wait” for resolution, but to reach a lasting decision with an eye to recurrent infection…
Vesicoureteral reflux in adults: In adults, vesicoureteral reflux is either a known diagnosis continuing from childhood, or it is found for the first time during recurrent pyelonephritis…
Vesicoureteral reflux in pregnancy: what does the risk actually depend on?: In women with a childhood history of vesicoureteral reflux or kidney scarring, the risk of urinary tract infection, pyelonephritis, and hypertensive disease…
How does follow-up work before and during pregnancy?: For a woman planning pregnancy who has a history of reflux or scarring, the most valuable step is clarifying the state of the kidneys before pregnancy.

Reflux that has not closed in adolescence: how much does it matter?

In a child who has reached adolescence, the chance of reflux closing on its own is now low; but at the same time, the chance of reflux damaging the kidney has also markedly decreased.

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As growth nears completion, the ureter's tunnel through the bladder wall no longer lengthens much further; moderate-to-high-grade reflux persisting past age ten is therefore mostly considered permanent. On the other hand, at this age the kidney no longer scars as easily as in infancy, and the frequency of febrile infection decreases; the real significance of reflux in adolescents is measured by the scarring it has already left behind. If there is a DMSA (renal scan) scar from childhood or reduced function, follow-up becomes important; if the kidneys are healthy, silent low-grade reflux is largely benign.
Yearly follow-up in adolescence again consists of ultrasound, blood pressure measurement, and urinalysis (especially for proteinuria); a single comprehensive reassessment is done at the start of adolescence. Repeated VCUG studies are not needed during adolescence; imaging is done only when it would change the treatment decision.

Treatment decisions in adolescents: surveillance, injection, surgery

Unlike in childhood, the goal of reflux treatment in adolescents is not to “wait” for resolution, but to reach a lasting decision with an eye to recurrent infection and quality of life.

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In an adolescent without febrile infections and with healthy kidneys, low-to-moderate grade reflux can be followed without treatment; antibiotic prophylaxis (CAP) is not continued for long at this age, because its benefit decreases while the risk of resistance accumulates. Recurrent febrile infection, new scarring, a high grade with a dilated system, or the young person's own preference brings corrective treatment to the forefront. Endoscopic injection (Deflux) can also be performed as a same-day procedure in adolescents; success rates by grade are similar to those in children. For high-grade reflux with a dilated ureter, open or laparoscopic/robot-assisted ureteral reimplantation (reconnecting the ureter to the bladder) achieves higher success.
In adolescents, bladder-bowel dysfunction and voiding habits are also reassessed; constipation, frequent holding, or incomplete emptying can be the real source of infection. In our practice, the adolescent remains under the care of the same two pediatric urologists, and the transition to adult care is planned without a break; since Doç. Dr. Yaşar Issı is also a specialist in adult urology, follow-up is never split because of age.

Vesicoureteral reflux in adults

In adults, vesicoureteral reflux is either a known diagnosis continuing from childhood, or it is found for the first time during recurrent pyelonephritis (kidney infection), hypertension, or family screening.

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For reflux newly found in an adult, one question is asked first: is this reflux causing harm? Low-grade reflux that has stayed silent for years, has not caused infection, and is present with healthy kidneys usually does not require treatment. Recurrent febrile infection, a single kidney, progressive loss of function, or a history of recurrent pyelonephritis before pregnancy brings corrective treatment into consideration. In adults, endoscopic injection and reimplantation are performed on the same principles; success rates are reported to be close to those in children, though the data are more limited.
In adults, the real subject of follow-up is most often not the reflux itself but the mark it left in childhood: reflux nephropathy (kidney scarring). A scarred kidney can show itself over the years through hypertension, protein leakage in the urine, and, rarely, declining function; this risk is higher with severe bilateral scarring. For this reason, every adult with a childhood history of reflux or scarring is advised to have their blood pressure checked and a urinalysis done once a year, with joint follow-up alongside nephrology if needed.

Vesicoureteral reflux in pregnancy: what does the risk actually depend on?

In women with a childhood history of vesicoureteral reflux or kidney scarring, the risk of urinary tract infection, pyelonephritis, and hypertensive disease (gestational hypertension, preeclampsia) in pregnancy is increased; but the real determinant of this risk is not the reflux itself, but the state of scarring and function in the kidney.

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In pregnancy, under the influence of hormones and the growing uterus, the ureters already dilate, urine flow slows, and susceptibility to infection increases; ongoing reflux can strengthen this tendency a little further. However, the literature consistently shows the following: in a woman with healthy kidneys and no scarring, a childhood history of reflux does not meaningfully change the course of pregnancy; by contrast, if there is significant scarring, reduced kidney function, or pre-existing hypertension, the pregnancy should be followed more closely. This distinction also answers the question “I have reflux — can I get pregnant?”: yes, but with a plan built around the state of your kidneys.
Guidelines (EAU/ESPU 2024) do not consider routine correction of persistent reflux before pregnancy an evidence-based practice; the decision is individual. In a woman planning pregnancy who has a history of recurrent pyelonephritis and persistent high-grade reflux, corrective treatment (injection or reimplantation) can be discussed; for silent, low-grade reflux, no intervention is needed before pregnancy.

How does follow-up work before and during pregnancy?

For a woman planning pregnancy who has a history of reflux or scarring, the most valuable step is clarifying the state of the kidneys before pregnancy.

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This is done with ultrasound, blood pressure measurement, urinalysis (protein), blood creatinine, and DMSA if needed; once scarring and function are known, pregnancy follow-up is shaped accordingly. Urinalysis, and culture if needed, is done at every pregnancy check-up; asymptomatic bacteriuria (bacteria in the urine without symptoms) is treated in this group, because the risk of it progressing to pyelonephritis is high. In recurrent infection, a low-dose antibiotic that is safe in pregnancy can be used prophylactically. Follow-up of blood pressure and protein leakage is carried out together with the obstetrician.
In our practice, this follow-up extending from adolescence into pregnancy proceeds along a single continuous line: records from pediatric urology are combined with adult urology knowledge, and a joint plan is made with nephrology and the obstetric team when needed.

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Frequently asked questions

My reflux is still there at age 15; won't it go away anymore?

After this age, the chance of spontaneous closure is low. But if you are not having infections and your kidneys are healthy, low-to-moderate grade reflux is mostly harmless and is followed with yearly check-ups. If you have recurrent infections, or if you prefer, same-day injection or surgical options are discussed.

Can someone with vesicoureteral reflux get pregnant?

Yes. If your kidneys are healthy and you have no scarring, a childhood history of reflux does not meaningfully affect pregnancy. If there is scarring, reduced function, or a history of recurrent pyelonephritis, the pregnancy is followed more closely; the pre-pregnancy evaluation exists to build this plan.

Should I have my reflux corrected before pregnancy?

Not routinely; guidelines do not consider this an evidence-based practice. If you have a history of recurrent pyelonephritis and persistent high-grade reflux, corrective treatment can be discussed on an individual basis. No intervention is needed for silent, low-grade reflux.

If reflux is first found in adulthood, is treatment always required?

No. Reflux that has stayed silent for years, has not caused infection, and has left the kidneys healthy is mostly followed with surveillance. Treatment comes into consideration if there is recurrent febrile infection, a single kidney, progressive loss of function, or recurrent pyelonephritis before pregnancy.

←Previous • By age and special situationsVUR in Young Children (1–5 Years): The Toilet-Training Years Next • By age and special situationsSecondary VUR: Neurogenic Bladder and Posterior Urethral Valves→

Related pagesFull index →

Kidney health and infectionIs Kidney Reflux Dangerous? Reflux Nephropathy and Renal ScarringThe honest answer to “is kidney reflux dangerous?” has two sides: reflux itself is harmless and temporary in most children; what truly matters is whether permanent kidney damage — reflux nephropathy, renal scarring — develops alongside a febrile infection. This page explains what scarring is, its two different types, how it is detected with DMSA, which children are at higher risk, and what can be prevented.Kidney health and infectionDoes VUR Cause Kidney Failure? Blood Pressure, Proteinuria, and FunctionThe deepest worry for families of children with kidney reflux (vesicoureteral reflux, VUR) is kidney failure. The truth is this: reflux itself does not cause kidney failure; the long-term risk is limited to the small number of children with extensive scarring in both kidneys, and even in these children, blood pressure and kidney function can be preserved for years with regular follow-up. This page explains how hypertension, proteinuria, and kidney function are monitored.After treatment and follow-upLong-Term Follow-up in VUR: Ultrasound, Blood Pressure, Urine, and Discharge from Follow-upEven after vesicoureteral reflux (VUR) has resolved on its own, or been treated with injection or surgery, follow-up continues for a while longer, because what really needs protecting is the kidney tissue itself. This page explains what is checked at the yearly visit, when DMSA is needed, when follow-up can be ended, and counseling during adolescence and pregnancy.BasicsIs VUR Genetic? Sibling and Child ScreeningVesicoureteral reflux (VUR) shows a familial predisposition: reflux is found in about 25–30% of the siblings of a child with reflux, and in about 30–35% of the children of a mother or father with a history of reflux. Most of this reflux is low-grade and silent; screening is done with ultrasound first, and a VCUG is obtained only for siblings in whom it is considered necessary.

Vesicoureteral Reflux (VUR) topic clustersMain treatment page →

Basics 6 Diagnosis and evaluation 6 By age and special situations 5 Bladder and bowel 5 Treatment pathways 10 Kidney health and infection 5 After treatment and follow-up 6

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