Treatments for Vesicoureteral Reflux (VUR) in Children

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Contact the Department of Urology

As a parent or caregiver, you are naturally concerned about your child's health and potential treatment options. Boston Children’s Urology Department is here to help. Our caring and experienced physicians and staff are dedicated to providing your child with state-of-the-art urologic care and surgical expertise when needed.

How will my child's VUR be treated?

We take a conservative approach to VUR at Boston Children's. Most children will outgrow their VUR on their own, so we allow for that to occur. During this time, it’s important that children with VUR be protected from infection. Most of our patients take a low-dose antibiotic once a day for a year or more while we wait for them to outgrow their VUR.

Some children will eventually require surgery, but not all. Surgery is typically recommended when a child has persistent kidney infections despite preventive antibiotics, or when VUR does not resolve on its own.

VUR occurs in varying degrees of severity. It may be mild, with only a small amount of urine backing up a short distance and not even reaching the kidneys, or it may be severe, with large volumes of urine causing the kidneys to be dilated (blown up like a balloon). The more severe the VUR, the higher the chances of UTI and kidney scarring, and the lower the chance that the VUR will go away on its own.

Based on the results of diagnostic VUR testing, your child's physician will usually assign a number score for the VUR. Scores range from 1 to 5 or 1 to 3, depending on the type of test that was performed. The higher the number, or score, the more severe the VUR.

Mild VUR

Mild VUR will likely improve on its own, and children with mild VUR are less likely to need surgery. Once VUR resolves itself, it is important for parents to know that a child can still get UTIs. However, we prescribe preventive antibiotics, especially if the child has had UTIs in the past. If your child gets frequent kidney infections, despite the antibiotics, she may need surgery to correct the VUR.

Severe VUR

The severe form of VUR is less likely to resolve on its own, and children with severe VUR are much more likely to require surgery.

How often do children with VUR need to be seen?

We usually see patients with VUR every six to 12 months. Infants may be seen more often. For children with persistent VUR, we recommend VUR testing every year to two years, depending on the child's age.

What do parents of a child with VUR need to look out for?

The most important issue for children with VUR is a urinary tract infection (UTI) Kidney infections can cause kidney damage, so parents need to watch for signs of UTI. In young children, this usually means a fever. Other signs of UTI include foul-smelling urine, pain with urination, blood in the urine, increased frequency of urination or wetting accidents, or flank and abdominal pain.

If surgery is recommended, what should we expect?

During the procedure, the surgeon makes an incision in the lower abdomen and exposes the bladder. The junction of the bladder and the ureter (the tube connecting the bladder to the kidney) is reconstructed to prevent urine from flowing backwards up into the kidney. A catheter is left in the bladder to drain the urine for the first one to two days after surgery.

Laparoscopic treatment

Laparoscopic surgery (inserting small instruments through several tiny incisions in the abdomen) for vesicoureteral reflux is being explored as a new alternative to traditional open surgery. Boston Children's is evaluating this possibility carefully, because the current success rate for open surgery is about 98 percent with few complications. Continued technical improvements in laparoscopic treatment will likely provide good alternatives to open surgery in the future. We have made great progress with robotic-assisted laparoscopic surgery for VUR, and some patients may be candidates for this technique.

For more information on laparoscopy, learn about Boston Children's approach to minimally invasive surgery

Endoscopic treatment

  • 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 scope 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. Talk to your Boston Children’s urology physician to discuss the best surgical option for your child.

Support services

We understand that VUR can be disruptive and of concern not only for your child, but for your whole family. From your first visit, you'll work with a team of professionals who are committed to providing your child with exceptional care and support.

We have a variety of resources at Boston Children's to assist you and your family:

Patient education: From office visits to inpatient testing or surgery, our nurses will be on hand to walk you through your child's treatment and help answer any questions you may have.

Parent to parent: Want to talk with someone else whose child has VUR? We can put you in touch with other families who have been down a similar road and can share their experience.

Social work: As part of Boston Children's broader social work program, our pediatric urology department has a dedicated professional who has helped many other families in your situation. Your social worker can offer counseling and assistance with issues such as coping with your child's diagnosis, dealing with financial difficulties and finding temporary housing near the hospital if your family is traveling to Boston from another area.

Visit our For Patients and Families site, and read all you need to know about:

  • getting to Boston Children's
  • accommodations
  • navigating the hospital experience
  • resources that are available for your family

Child life specialists

Caring for your child goes beyond a medical diagnosis and treatment. Here at Boston Children’s, our child life specialists are dedicated to easing the fear and anxiety associated with the hospital experience and giving special consideration to each child's family, culture and stage of development.  

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.”
- Sandra L. Fenwick, President and CEO

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