In healthy people, the direction of the urine is one-way; it travels from the kidney through ureters toward the bladder. Vesicoureteral reflux (VUR) is a condition that occurs when the urine which is stored in the bladder flows backward to either ureters or kidneys. In these circumstances, the bacteria which is present in the balder will also move to the kidneys and may cause infections and damage its function. Usually, 10 of every 100 healthy children are affected with VUR; therefore, the condition often happens in infants and young children.

In the ureter, there is a flap valve that connects to the bladder, which prevents the urine from returning to the ureter or kidneys. In patients who have been diagnosed with vesicoureteral reflux, the flap valve will get damaged and cannot work correctly, leading to the backflow of urine. Generally, there are two types of development for Vesicoureteral reflux which will be explained briefly:

• Primary vesicoureteral reflux: In children who have been diagnosed with primary vesicoureteral reflux, the defective valve is present from birth.
• Secondary vesicoureteral reflux: In this type, the cause of the backflow of the urine could be due to balder failure, blockage, or damage to the balder muscles or nerves.

One of the most visible signs of children who have developed vesicoureteral reflux is urinary tract infection (UTI). Research has shown that one of every three children who have been impacted with vesicoureteral reflux found to have UTI. Below some of the common symptoms will be explained:

• Kidney infection: 
• Feeling under the weather
• Fever
• A feeling of nausea
• Feeling sick in the stomach
• Bladder Infection:
• Frequent urination
• A frequent need to pass urine
• Bed-wetting

Before the child is born, testing can be an effective tool for vesicoureteral reflux diagnosis. Vesicoureteral reflux can occur at any age, but most often children between the age of 2 to 3 are more susceptible. Furthermore, a urine test can show if the child has UTI, but for the accurate diagnosis of VUR, the doctor will recommend the following tests:

Voiding cystourethrogram (VCUG): A special test that uses x-ray imaging to examine the urinary tract by inserting a catheter into the urethra. 

Abdominal ultrasound:  If the doctor determines that the child does not need to be exposed to x-ray radiation, the Abdominal ultrasound will be performed. The test uses ultrasound to check the size and shape of kidneys, bladder, or ureters.

The goal of vesicoureteral reflux surgery is to fix the faulty valves, which are placed between the bladder and ureter. Two surgical procedures, according to the grading of reflux and the degree of severity will be advised.

Open surgery:  The operation is usually required the patients to be administered general anesthesia. Afterward, the surgeon will make a small incision below the abdomen to repair the damaged flap valve. When the valves are repaid, a catheter will be inserted into the incision area to empty the bladder.

Robotic-assisted laparoscopic surgery: Although research suggests that robotic-assisted laparoscopic may not be as effective as open surgery, only a tiny incision is required to repair the valve. Also, patients will be discharged from the hospital sooner.  

Endoscopic surgery: In this procedure, a cystoscope will be inserted through the urethra to examine the bladder. Following that, in order to strengthen the valve to be able to close properly, a substance will be injected into the ureter’s surrounding area. 

In the beginning, ureteral anatomy was first depicted by drawing of Leonardo da Vinci, and later on, he proposed a mechanism that acted as an anti-reflux in preventing the backflow of the urine. Over the years, the management of vesicoureteral reflux has evolved rapidly leading to various types of treatments. In Iran, conclusive research has been put forth that has changed the conventional landscape in curing VUR and has given the Iranian urologist a new perspective. Nowadays, Iran not only follows the footsteps of pioneers but has also contributed tremendously to the understating of some of the best types of treatments for people who have developed vesicoureteral reflux. In treating patients with VUR, Iranian surgeons adhere to the global guidelines for managing this condition; therefore, foreign patients can feel confident that their treatment will be performed with absolute minimal risk and with the most promising outcome.