Vesicoureteral Reflux Program | Tests and Treatment

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VUR is diagnosed using one of two similar tests, called a voiding cystourethrogram (VCUG) and a radionuclide cystogram (RNC). In these tests, a small catheter is passed through the child’s urethra into the bladder. The bladder is then filled with a liquid that is visible using specialized imaging equipment. If the fluid refluxes backward up to the kidney, VUR is diagnosed. Each test usually takes 15 to 45 minutes. Sometimes it may last longer, if your child does not void (urinate) quickly. Although the RNC and VCUG are similar tests, your doctor may have specific reasons for ordering one or the other.

DMSA renal scan: this is a nuclear medicine study in which a chemical called a radiotracer is injected through an IV into your child’s bloodstream. The radiotracer collects in the kidney (this may take a couple of hours). The child then lies on an imaging table and a special detector creates detailed images of the kidneys. This test gives us important information about the function of each kidney and whether there has been damage from infection.

Kidney ultrasound: this non-invasive test is performed by placing a small probe on the child’s back or abdomen. It can see evidence of kidney growth or obstruction, and sometimes can identify scarring or damage to the kidney tissue. It can also evaluate the bladder for other problems that may lead to urinary tract infection.

If a child is suspected of having a urinary tract infection (UTI), the urine needs to be sampled using special techniques to avoid contamination and false test results. For younger children and infants, this usually means passing a catheter into the bladder to obtain a urine sample. In some cases, a bag will be placed on the child to collect urine, although this method has a high rate of false results. In older, toilet-trained children, the child can void (urinate) into a cup; however, great care must be taken to make sure the urine sample is uncontaminated by germs located on the skin.

Treatment for Vesicoureteral Reflux in Children

Most commonly, we will treat your child for VUR in two ways:

  • Observation: we will observe your child for varying periods of time, while he or she is on prophylactic antibiotics.
  • Surgery: although the majority of VUR cases will get better on their own, surgery is performed to correct the reflux if:
    • The grade level, or severity is high.
    • Kidney damage is detected.
    • Breakthrough urinary tract infections occur, while on antibiotics.
    • Antibiotics for a particular child are not recommended.
    • The reflux does not resolve after watching and waiting for a long time.
Surgical treatment for vesicoureteral reflux at Boston Children’s may include:
  • Ureteral reimplant surgery: a surgical procedure where the connection between the ureter tubes and the bladder is reconstructed, to prevent VUR.
  • Endoscopic treatment of VUR: a procedure where a small scope is inserted into the bladder and a pasty substance is injected into the wall of the bladder near the ureter, to prevent VUR.
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