Vesicoureteral Reflux

Vesicoureteral Reflux

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Hearing that your child may have vesicoureteral reflux (VUR) can be frightening. It’s a complicated name for when urine flows in the wrong direction: from the bladder up the ureters and toward the kidneys, instead of down and out of the body. VUR is usually a birth defect that is most often found in children age two and younger, although it can occur in children of all ages.

At Duke, our pediatric urology team take a step-by-step approach to make sure your child gets the right treatment with the least long-term impact.

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Why Treatment for Vesicoureteral Reflux Is Important

The good news is that VUR doesn’t present immediate problems and may improve or resolve as your child gets older. But without treatment, it could allow a bladder infection to progress into a kidney infection. Our pediatric urology providers often recommend a treatment plan that starts with monitoring the bladder and kidneys and may include prescribing antibiotics to prevent urinary tract infections (UTIs). In severe cases, your child’s provider may recommend surgery to cure the VUR and avoid permanent damage to the kidneys.

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Duke Health offers locations throughout the Triangle. Find one near you.

Diagnosing VUR

VUR is often found when a child has swelling of a kidney due to a build-up of urine and/or a severe UTI. About a third of children with a UTI that is accompanied by a high fever are found to have VUR.

A doctor may also suspect VUR if your child has:

  • Bladder control problems, including those caused by brain, spinal cord, or nerve problems
  • Bladder exstrophy
  • Hydronephrosis or hydroureter (enlargement of the kidneys or tubes that carry urine from the kidneys to the bladder))
  • Posterior urethral valves (extra tissue in males that blocks the flow of urine from the bladder to the penis)
  • Prune belly syndrome (a rare disorder in which a child’s urinary tract may not form properly)
  • Spina bifida

To determine whether your child has VUR, your provider may recommend:

Ultrasound
High-frequency sound waves create images of your child’s bladder, kidneys, and urinary tract. This allows the provider to look for any abnormalities.

Voiding Cystourethrogram (VCUG)
This specialized X-ray allows providers to see what happens when urine moves through your child’s urinary tract. It’s typically the only way to fully diagnosis VUR and helps determine the best treatment for each individual.

Vesicoureteral Reflux Treatments

If your child is diagnosed with VUR, the provider will also “grade” the severity of their condition on a scale of one to five. Grade one is mild and grade five is the most severe. Your child’s provider will use the severity grade, along with your child’s age and symptoms, to recommend a treatment plan. Treatment may include:

Medication

A low-dose of an antibiotic is often prescribed to reduce chances of kidney or bladder infection. How long the medication is taken is individualized for each child.

Bulking Injection with Deflux

If your child has VUR that doesn’t respond to antibiotics or doesn’t get better over time, one option may be a minimally invasive procedure that includes general anesthesia. In this procedure, a surgeon will pass a narrow telescopic instrument called a cystoscope into the urinary tract and guide it to the bladder. The surgeon will then inject an FDA-approved gel called Deflux into the bladder wall, near the faulty valve in the ureter that has allowed urine to flow back toward the kidneys. The gel creates a small mound that helps the valve close and prevents urine from flowing in the wrong direction. Your child will go home the same day of the procedure. However, this treatment may not be as permanently effective as surgery.

Surgery

For some children with severe or persistent VUR, the best option may be surgery that requires general anesthesia. This procedure can be done open, robotically, or as a minimally invasive procedure with a laparoscope to view organs with a small camera. In all cases, surgeons make a small incision in your child’s abdomen to repair the valve between your child’s ureter and bladder to keep urine from flowing back toward the kidneys.

Open surgery is done through an incision of a few inches below the abdomen, and robotic or laparoscopic surgery is typically done through three small incisions about the size of your fingertip in the same location. Your child may spend one or two nights in the hospital recovering from the surgery, which is nearly 100% effective in permanently fixing VUR.

Why Choose Duke

Individualized Treatment
Your child’s VUR treatment plan will be tailored to their specific needs with particular attention to short-term and long-term health and safety.

Specialists in Caring for Young Patients
Our pediatric urology team -- including our nurses, surgeons, anesthesiologists, and pharmacists -- are specially trained in caring for children. We consider the whole child, including their stage of physical, emotional, social, and intellectual development.

Advancing Research in VUR Treatment
Duke pediatric urologists are also researchers committed to staying on the cutting edge of the diagnosis and treatment of VUR.  We participate in ongoing, government-funded research to improve the management of VUR.

Recognized for Quality Care
Our pediatric urology providers are part of Duke Children’s, one of only several hospitals in the U.S. certified as a Level I Verified Children’s Surgery Center  by the American College of Surgeons. This is the highest level of distinction for hospitals that perform complex surgical procedures for newborns, children and teens. Duke is the only children’s hospital in North or South Carolina to receive this designation. 

Family Support Services
Our Child and Adolescent Life team will work with your family to make your child’s experience with procedures and treatments as comfortable as possible.

Reviewed: 08/28/2019