Treatment options for vesicoureteral reflux depend on the severity of the condition. Children with mild cases of primary vesicoureteral reflux may eventually outgrow the disorder. In this case, your doctor will likely recommend a wait-and-see approach. During this time, it will be important for you to be watchful for potential UTIs and to seek prompt treatment.
Children with moderate to severe primary vesicoureteral reflux have two treatment options: medication and surgery. Using medication is more common, with surgery usually reserved for those children for whom antibiotics aren't successful.
However, surgery may be a first line therapy for grades IV and V or for families who prefer a quicker, more definitive treatment than medication.
UTIs require prompt treatment with antibiotics to keep the infection from moving to the kidneys. Doctors may also use antibiotics to prevent UTIs, usually at about half the dose for treating an infection.
Commonly used antibiotics for prevention include the combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra), trimethoprim (Primsol) and nitrofurantoin (Furadantin, Macrobid, Macrodantin). Some people may be allergic to one or more of these medications, preventing their use. Possible side effects of long-term use of these drugs include:
- Nausea and vomiting
- Abdominal pain
- Increased antibiotic resistance, in which the infection no longer responds to antibiotics and becomes more difficult to treat
A child being treated with medication needs to be monitored for as long as he or she is taking antibiotics. This includes periodic physical exams and urine tests to detect breakthrough infections — UTIs that occur despite the antibiotic treatment — and occasional radiographic scans of the bladder and kidneys to determine if your child has outgrown vesicoureteral reflux.
Surgery for vesicoureteral reflux repairs the defect in the functional valve between the bladder and each affected ureter that keeps it from closing and preventing urine from flowing backward. There are two methods of surgical repair:
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- Open surgery. Performed using general anesthesia, this surgery requires an incision in the lower abdomen through which the surgeon repairs the malformation that's causing the problem. This type of surgery usually requires a few days' stay in the hospital, during which a catheter is kept in place to drain your child's bladder. Risks include infection, blood clots and bleeding.
- Endoscopic surgery. In this procedure, the doctor inserts a lighted tube (cystoscope) through the urethra to see inside your child's bladder, then injects a bulking agent around the opening of the affected ureter to try to strengthen the valve's ability to close properly. This method is minimally invasive compared with open surgery and presents fewer risks, though it may not be as effective. This procedure also requires general anesthesia, but generally can be performed as outpatient surgery.
- Vesicoureteral reflux. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/Kudiseases/pubs/vesicoureteralreflux/. Accessed June 3, 2011.
- Ureteral anomalies. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/sec19/ch290/ch290c.html. Accessed June 3, 2011.
- Urinary tract infection in adults. National Kidney and Urologic Diseases Information Clearinghouse. http://www.kidney.niddk.nih.gov/kudiseases/pubs/utiadult/. Accessed June 3, 2011.
- McLorie G, et al. Presentation, diagnosis, and clinical course of vesicoureteral reflux. http://www.uptodate.com/home/index.html. Accessed May 25, 2011.
- Fever. American Academy of Pediatrics Healthy Children. http://www.healthychildren.org/english/tips-tools/symptom-checker/pages/Fever.aspx. Accessed June 5, 2011.
- Elder JS. Vesicoureteral reflux. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-6/0/1608/0.html. Accessed June 3, 2011.
- McLorie G, et al. Management of vesicoureteral reflux. http://www.uptodate.com/home/index.html. Accessed May 25, 2011.