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Based on the results of diagnostic vesicoureteral reflux (VUR) testing, a physician will usually assign a number score for the VUR. Scores range from one to five or one to three, depending on the type of test performed. The higher the number or score, the more severe the VUR.
Children with mild VUR will likely improve over time and are less likely to need surgery. Once VUR resolves itself, it is important for parents to know that their child may still get UTIs.
If a child has more severe VUR or gets frequent kidney infections, despite preventative antibiotics, he or she may need surgery to correct the VUR. The severe form of VUR is less likely to resolve on its own.
Ureteral reimplantation surgery is a surgical procedure where the connection between the ureter and the bladder is reconstructed to prevent VUR.
Endoscopic treatment is an option for some children who have lower grades of VUR. The procedure is performed on an outpatient basis under general anesthesia.
The doctor inserts a small telescope into the bladder through the urethra (the tube connects the bladder to the outside) and injects a small amount of gel-like material under the opening of the ureter. The injected material partially closes the opening and prevents the urine from going backwards toward the kidney.
The success rate of this procedure is about 75 percent, and there are very few complications. However, we do not know how long the results will last, since some children can have recurrence of their VUR months or years later. Although there are some advantages to endoscopic treatment, it is not always the best option.
Robot-assisted laparoscopic surgery is performed by inserting small instruments through several tiny incisions in the abdomen. This procedure is normally performed in patients that require repeat surgery for VUR or to treat VUR in adolescents and young adults. The approach is rarely performed in younger children because the success rate for open surgery is better (about 98%) and with few complications.
Continued technical improvements in robotic surgical treatment will likely provide good alternatives to open surgery in the future. We have made great progress with robotic-assisted laparoscopic surgery for VUR.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”