How is Vesicoureteral Reflux Treated?

So how do you treat Vesicoureteral Reflux? For the purpose of this article I am going to talk about the most commonly accepted treatment methods. You should know that they are widely debated. There are some articles discussing some of that debate at the end of this article if you are interested in reading more.

Treatment for VUR is based on the grade of reflux. After diagnosis, the child is almost always started on a prophylactic antibiotic, which is a daily, low dose of antibiotic. The hope is that the abx will kill any bacteria before they can cause an infection. If there is no bacteria present, there will no UTI, and therefore no infection in the kidneys that can cause scarring and damage. In recent years there has been a lot of debate as to whether this approach is effective or safe. For more information about prophylatic antibiotics and which types are used click here.

For grades 1-3, the child is given daily abx, and then routinely monitored for any changes. Since about 80% of children in this group have spontaneous resolution, there may be no need for any other treatment, however monitoring should continue until the VUR has resolved. If the child has breakthrough infections, Endoscopic treatmet (Deflux) may be a good option for correcting the reflux in these lower grades.

In grades 4-5, (sometimes 3 is also included in this group), abx are also started, and the child is routinely monitored. In the higher grades, spontaneous resolution is much less likely. For these children, Deflux injection, or reimplantation surgery may be required if the VUR does not resolve on it's own, or if there are problems with breakthrough UTIs. If there are breakthrough infections, surgery may be considered, although most doctors try to delay surgery until the age of 18 months (except in cases of recurrent infection, or kidney damage).

There is a lot of debate on the treatment of VUR, but the overall goal is always to keep the kidneys healthy. From my experience and research, the first step is to start a child on abx regardless of the grade (again, the effectiveness of antibiotics is widely debated). For all grades, if the child is under the age of 5, there is a waiting period when possible to give the child time to grow. The hope is that there may be some type of resolution (don't forget, there is still a 10% chance that even grade 4 will resolve). A VCUG is performed yearly to monitor the child's condition. When there are breakthrough infections, an aggressive approach may be needed to correct the reflux. Deflux is generally used for the lower grades, and the higher grades require ureteral reimplantation.

Deflux has generally around 80% or higher success rate, and can be repeated for even higher success rates. Reimplantation has a 95% or better success rate, but is much more invasive. You should discuss your options in detail with your urologist, and do your own research. For more on Deflux click here. For more on reimplantation, click here.

For the very small percentage of failed reimplantation surgeries (of which Lizzie is a part), the child should undergo urodynamics study to rule out abnormalities in the bladder which may be causing the VUR. An MRI might also be a good option to rule out any neurologic problems which might be causing the VUR. Lizzie has done both of these tests in the past few months, and both have given us a great deal of information.

For a more indepth look at each of these treatment options, please check out the following articles:

Antibiotics for Treating VUR
The Argument against Prophylactic Antibiotics
Ureteral Reimplantation in correcting VUR
Endoscopic Treatment of Reflux (Deflux)

Vesicoureteral Reflux, Symptoms of Reflux, Grades of Reflux, Testing for Reflux, Treatment for Reflux

 

The information on this web site should not be taken as medical advice, and you should contact your health care provider with any questions regarding your child's condition/health. The information on this site comes from the personal experience and opinions of parents, and does not come from doctors or medical experts, and should be taken as such.