Treatment options for vesicoureteral reflux depend on the severity of the condition. Children with mild cases of primary vesicoureteral reflux may eventually outgrow the disorder. In this case, your doctor will likely recommend a wait-and-see approach.
For more severe vesicoureteral reflux, treatment options include:
UTIs require prompt treatment with antibiotics to keep the infection from moving to the kidneys. To prevent UTIs, doctors may also prescribe antibiotics at a lower dose than for treating an infection.
A child being treated with medication needs to be monitored for as long as he or she is taking antibiotics. This includes periodic physical exams and urine tests to detect breakthrough infections — UTIs that occur despite the antibiotic treatment — and occasional radiographic scans of the bladder and kidneys to determine if your child has outgrown vesicoureteral reflux.
Surgery for vesicoureteral reflux repairs the defect in the functional valve between the bladder and each affected ureter that keeps it from closing and preventing urine from flowing backward.
Methods of surgical repair include:
Jun. 20, 2014
Open surgery. Performed using general anesthesia, this surgery requires an incision in the lower abdomen through which the surgeon repairs the malformation that's causing the problem.
This type of surgery usually requires a few days' stay in the hospital, during which a catheter is kept in place to drain your child's bladder. Vesicoureteral reflux may persist in a small number of children, but it generally resolves on its own without need for further intervention.
- Robotic-assisted laparoscopic surgery. Similar to open surgery, this procedure involves repairing the valve between the ureter and the bladder, but it's performed using small incisions. Preliminary findings suggest that robotic-assisted laparoscopic surgery has similar success rates to open surgery. It was also associated with a longer operating time, but a shorter hospital stay.
Endoscopic surgery. In this procedure, the doctor inserts a lighted tube (cystoscope) through the urethra to see inside your child's bladder, then injects a bulking agent around the opening of the affected ureter to try to strengthen the valve's ability to close properly.
This method is minimally invasive compared with open surgery and presents fewer risks, though it may not be as effective. This procedure also requires general anesthesia, but generally can be performed as outpatient surgery.
- Wein AJ, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed April 1, 2014.
- Vesicoureteral reflux. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/Kudiseases/pubs/vesicoureteralreflux/. Accessed April 1, 2014.
- Vesicoureteral reflux. The Merck Manuals: The Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/pediatrics/congenital_renal_and_genitourinary_anomalies/vesicoureteral_reflux.html. Accessed April 1, 2014.
- Urinary tract infection in adults. National Kidney and Urologic Diseases Information Clearinghouse. http://www.kidney.niddk.nih.gov/kudiseases/pubs/utiadult/. Accessed April 1, 2014.
- Tekgul S, et al. EAU guidelines on vesicoureteral reflux in children. European Urology. 2012;62:534.
- Fever and your child. American Academy of Pediatrics. http://patiented.aap.org/content2.aspx?aid=5107. Accessed April 6, 2014.
- McLorie G, et al. Management of vesicoureteral reflux. http://www.uptodate.com/home. Accessed April 3, 2014.
- Castle EP (expert opinion). Mayo Clinic, Rochester, Minn. April 6, 2014.
- Schmitt BD. Pediatric Telephone Protocols. 14th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2013:120-124.
- McLorie G, et al. Presentation, diagnosis, and clinical course of vesicoureteral reflux. http://www.uptodate.com/home. Accessed April 30, 2014.
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