VUR can occur in varying degrees of severity. It can be very mild, when urine backs up only a short distance in the ureters. Or, it can be severe and lead to kidney infections and permanent kidney damage (scarring). A Children’s National, specific treatment for VUR will be determined by your child's doctor based on:
- Your child's age, overall health, and medical history
- The severity or grade of reflux
- Your child's ability to take specific medications, procedures, or therapies
- Possibility of the reflux going away on its own
- Your opinion or preference
Your child's doctor may assign a grading system (ranging from 1-5) to indicate the degree of reflux. The higher the grade, the more severe the reflux.
VUR Grade 1-3
Most children who have grade 1 through 3 VUR do not need any type of intense therapy. The reflux resolves on its own over time, usually within five years. Children who develop frequent fevers or infections may require ongoing preventive antibiotic therapy and periodic urine tests.
Preventive antibiotics have been shown to stop urinary infection s in some cases and pose little risk of problems. They do not make your child less immune to disease or infection. The doses used are very low, just enough to prevent a urinary infection from starting. While you are waiting for the reflux to go away, it is sometime best to keep your child on a preventive antibiotic so that they do not have more infections.
Surgical treatment is also available.
VUR Grade 4-5
Children who have grade 4 and 5 reflux may require surgery. During the procedure, the surgeon will create a flap-valve apparatus for the ureter that will the urine from flowing into the kidney. In more severe cases, the scarred kidney and ureter may need to be surgically removed.
The procedure can be performed through endoscopic surgery, open surgery or robot-assisted laparoscopic surgery.
- Endoscopic surgery is offered for simple, low-grade VUR and consists of inserting a cystoscope through the urethra into the bladder. A paste called Deflux® is injected under the ureter to correct the VUR.
- Open surgery is done through a lower abdominal incision (bikini incision), the bladder is opened and the ureters are repaired in such a way to prevent more reflux. The success rate is very high (95 – 97%).
- Laparoscopic surgery with robotic assistance (DaVinci) can now be performed at selected hospitals and offers a generally shorter hospital stay and more rapid recovery with three small incisions.