Vesicoureteral Reflux Health Article

Treatment

Treatment depends on the grade that is diagnosed. In grades I and II, the usual treatment involves long-term use of a small daily dose of antibiotics to prevent the development of infections. The urine is tested regularly to make sure that no infection occurs. The kidneys are evaluated regularly via ultrasound and VCUG (every 12 to 18 months) to make sure that they are growing normally and that no new scarring has occurred. Grades III, IV, and V VUR can be treated with antibiotics and careful monitoring. New infections, scarring, or stunting of kidney growth may result in the need for surgery. Grades IV and V are extremely likely to require surgery.

Surgery for VUR consists of reimplanting the ureters into the bladder at a more normal angle. This adjustment usually improves the functioning of the valve leading into the bladder. When structural defects of the urinary system are present, surgery will almost always be required to repair these defects.

Prognosis

Prognosis is dependent on the grade of VUR. About 80 percent of children with grades I and II VUR simply grow out of the problem. As they grow, the ureter lengthens, changing its angle of entry into the bladder and resolving the reflux. The average age of VUR resolution is about six to seven years. About 50 percent of children with grade III VUR require surgery. Nearly all children with grades IV and V VUR require surgery. In these cases, it is usually best to perform surgery when the patient is relatively young, in order to avoid damage and scarring to the kidneys.

Prevention

While as of 2004 there was no known method of preventing VUR, it is important to note that a high number of the siblings of children with VUR also have VUR. Many of these siblings (about 36%) have no symptoms but are discovered through routine examinations prompted by their brother's or sister's problems. It is important to identify these children, so that antibiotic treatment can be used to prevent the development of infection and kidney damage.

Parental concerns

It is important that parents of children with VUR understand the importance of following the instructions for antibiotic administration. Although their child may not appear at all ill, the antibiotics are crucial to protecting the health and development of their child's kidneys. Children with VUR should also be monitored for the development of constipation, which can complicate the VUR. Problems with bladder emptying can make toilet teaching a slower process in children with VUR.

BOOKS

Atala, Anthony, and Michael A. Keating. "Vesicoureteral reflux and megaureter." In Campbell's Urology, 8th ed. Edited by Meredith F. Campbell et al. St. Louis, MO: Elsevier, 2002.

"Vesicoureteral reflux." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

PERIODICALS

Austin, J. "Vesicoureteral reflux: Surgical approaches." In Urology Clinics of North America 31 (August 2004).

Cooper, C. "Vesicoureteral reflux: Who benefits from surgery?" In Urology Clinics of North America 31 (August 2004).

Rosalyn Carson-DeWitt, MD