It's entirely natural that you might be concerned, right now, about your child's health; a diagnosis of vesicoureteral reflux (VUR) can be frightening. But you can rest assured that at Boston Children's Hospital, your child is in good hands.
How will my child's VUR be treated?
We take a conservative approach to VUR at Children's. Most children will outgrow their VUR on their own, so we give them a chance to do that. It's very important that children with VUR be protected from infection, so we prescribe preventive antibiotics. Most of our patients take an 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. The most common reasons we recommend surgery to correct VUR are continued kidney infections despite preventive antibiotics, or VUR that does not resolve on its own.
VUR occurs in varying degrees of severity. It may be very mild, with only a small amount of urine only backing up a short distance and not even reaching the kidney, 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 the testing that diagnoses your child's VUR, Your child's physician may 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, the more severe the VUR.
Mild VUR will resolve on its own, and children with this form are less likely to need surgery. They can still get UTIs, however, so 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.
The severe form of VUR is less likely to resolve on its own, and children with this it require surgery more often.
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 whose VUR has not yet gone away, tests for VUR are usually performed 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.
What happens during surgery for VUR?
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 backward 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 surgery (inserting small instruments through several tiny incisions in the abdomen) for vesicoureteral reflux is being explored as a new alternative to the usual open surgery. Children's is evaluating this possibility carefully, because the current success rate for open surgery is about 98 percent, with very few complications. Continued technical improvements in this method 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 Children's approach to Minimally Invasive Surgery.
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. Therefore, although there are some advantages to endoscopic treatment, it is not always the best option.
Coping & support
We understand that VUR be disruptive and frightening—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 supporting you.
We have a variety of resources at Children's to help 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. They will also reach out to you by phone, continuing the care and support you receive while you're at Children's.
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.
Faith-based support: If you and your family find yourself in need of spiritual support, we can connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during your treatment experience.
Social work: As part of 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.
On our For Patients and Families site, you can read all you need to know about:
- getting to Children's
- navigating the hospital experience
- resources that are available for your family
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