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Vesicoureteral Reflux/VUR (Pediatric)

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What is vesicoureteral reflux?

Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder to the upper urinary tract. VUR affects about 1 percent of all children in the United States and is typically diagnosed after urinary tract infection with fever (UTIs) or antenatal hydronephrosis. Children with VUR may also have constipation and/or fecal soiling problems and issues with urinating normally.

Females are twice as likely as males to develop VUR, but males are often diagnosed earlier and usually have more severe reflux and generalized kidney damage. Females have a high risk of dysfunctional urination and recurrent urinary tract infections.

Children with VUR are prone to kidney infections because the backward flow of urine moves bacteria from the bladder to the upper urinary tract. The immunological and inflammatory reactions that result from the infections may cause permanent kidney injury and scarring. VUR is also associated with difficulties during pregnancy in women who had VUR as children. The risk of complications decreases the earlier VUR is diagnosed. About 30 percent of patients have evidence of renal scarring at that time.

There are two types of VUR:

  • Primary reflux occurs in an otherwise normal lower urinary tract.
  • Secondary VUR is most often associated with an abnormality of the urinary tract such as obstruction

Who is affected by vesicoureteral reflux?

Females are twice as likely as males to develop vesicoureteral reflux​, but males are often diagnosed earlier and usually have more severe reflux and generalized kidney damage. Females have a high risk of dysfunctional urination and recurrent urinary tract infections.

Children with vesicoureteral reflux​ are prone to kidney infections because the backward flow of urine moves bacteria from the bladder to the upper urinary tract. The immunological and inflammatory reactions that result from the infections may cause permanent kidney injury and scarring. 

Vesicoureteral reflux​ is also associated with difficulties during pregnancy in women who had the condition as children. The risk of complications decreases the earlier this condition is diagnosed. About 30 percent of patients have evidence of renal scarring at that time.

How is vesicoureteral reflux treated?

Our doctors aim to prevent kidney infections and long-term complications such as renal scarring and failure. We recommend specific treatments based on the grade and severity of reflux. Treatment options are:

Medical management with long-term antibiotic prophylaxis.

This approach is recommended by the American Academy of Pediatrics, the American Urologic Association, and the Swedish Medical Research Council. However, these groups acknowledge that antibiotic prophylaxis is not heavily supported by well-designed, randomized clinical trials especially for low grade reflux.

Conventional open surgery or minimally invasive endoscopic surgery.

Our doctors may decide that surgical correction is needed in children whose reflux does not resolve over time or children who have recurrent infections while on antibiotic therapy. There are three surgical options:

Conventional open surgery

This is the most effective method to eradicate reflux. However, open surgery entails general anesthesia and a hospital stay, and leaves the child with an abdominal incision.

Minimally invasive robotic surgery (MIS) 

Our pediatric urologists perform conventional open surgery to correct reflux through 3 small incisions in the abdomen allowing for a quicker and easier recovery.

Minimally invasive endoscopic surgery (MIS)

Our pediatric urologists also treat some cases of VUR with a less invasive, endoscopic procedure in which they inject the sugar-based gel Deflux around the ureter opening. The gel creates a valve-like formation that allows urine to flow from the ureter into the bladder but prevents it from flowing back up the ureter.