Options for treating VUR depend on your specific child and on the doctor.
How VUR is managed, depends on the grade of reflux. This is determined by the VCUG. The frequency of UTIs, the presence and progression of any kidney damage, and the opinion of the parent are also considered.
International Reflux Classification. Adapted from (2002) Vesicoureteral Reflux. In: Belman, King, Kramer (eds.) Clinical Pediatric Urology. London, England: Martin Dunitz, Ltd., 753.
For grades I-III there is a good chance that the reflux will go away as the child grows and the bladder matures. These children are given low-dose antibiotics daily. This will suppress bacteria from growing. Occasional blood tests and urine cultures may be ordered.
An option for patients with VUR is a cystoscopy with injection of Deflux. This is a procedure where, under general anesthesia, a small telescope is put into the bladder through the urinary opening. A gel (Deflux) is injected where the ureters enter the bladder. A little bulge is formed in the bladder wall. This prevents the backflow of urine. This is an outpatient procedure.
Patients with "high grade" reflux, grades IV-V, will take low dose antibiotics and have periodic blood tests, X-ray tests and urine cultures done. These children may need ureteral reimplantation surgery to correct the reflux and prevent progressive damage of the kidneys.
Ureteral Reimplantation Surgery
The goals of surgery are to:
- Correct the reflux
- Prevent pyelonephritis (kidney infection)
- Preserve renal function
This may not totally stop bladder infections. It will reduce the chance that a bladder infection will develop into a kidney infection though.
The ureteral reimplantation surgery consists of making a longer tunnel of the ureter through the bladder wall. The surgery is done through an incision (cut) just above the pubic bone (bikini incision) or laproscopicly. If both ureters need to be reimplanted, this is done through one incision.
This surgery most often lasts between 2½ and three hours. The child may be admitted to the hospital for two to four days after the surgery. Before surgery, the anesthesiologist will discuss a pain management plan with the family.
After open surgery, activity will be limited for four to six weeks. No tub baths for five days. Return to school can be one week after surgery or when no longer taking narcotics for pain control.
After reflux surgery, there may be limits on physical activity. This will be based on what your surgeon decides. Voiding every two to three hours as well as drinking adequate fluids helps healing. Your child may return to school the day after surgery.