Diagnosis

Urinalysis — lab analysis of a urine sample — can reveal whether your child has a UTI. Other tests are necessary to determine the presence of vesicoureteral reflux, including:

  • Kidney and bladder ultrasound. Also called sonography, this imaging method uses high-frequency sound waves to produce images of the kidney and bladder. Ultrasound can detect structural abnormalities.

    This same technology, often used during pregnancy to monitor fetal development, may also reveal swollen kidneys in the baby, an indication of primary vesicoureteral reflux.

  • Voiding cystourethrogram (VCUG). This test uses X-rays of the bladder when it's full and when it's emptying to detect abnormalities. A thin, flexible tube (catheter) is inserted through the urethra and into the bladder while your child lies on his or her back on an X-ray table.

    After contrast dye is injected into the bladder through the catheter, your child's bladder is X-rayed in various positions. Then the catheter is removed so that your child can urinate, and more X-rays are taken of the bladder and urethra during urination to see whether the urinary tract is functioning correctly.

    Risks associated with this test include discomfort from the catheter or from having a full bladder and the possibility of a new urinary tract infection.

  • Nuclear scan. This test, known as radionuclide cystogram, uses a procedure similar to that used for VCUG, except that instead of dye being injected into your child's bladder through the catheter, this test uses a radioactive tracer (radioisotope). The scanner detects the tracer and shows whether the urinary tract is functioning correctly.

    Risks include discomfort from the catheter and discomfort during urination. Your child's urine may be slightly pink for a day or two after the test.

Grading the condition

Doctors grade vesicoureteral reflux according to the degree of reflux. In the mildest cases, urine backs up only to the ureter (grade I). The most severe cases involve severe kidney swelling (hydronephrosis) and twisting of the ureter (grade V).

Treatment

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.

For more severe vesicoureteral reflux, treatment options include:

Medications

UTIs require prompt treatment with antibiotics to keep the infection from moving to the kidneys. To prevent UTIs, doctors may also prescribe antibiotics at a lower dose than for treating an infection.

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

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.

Methods of surgical repair include:

  • 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. Vesicoureteral reflux may persist in a small number of children, but it generally resolves on its own without need for further intervention.

  • Robotic-assisted laparoscopic surgery. Similar to open surgery, this procedure involves repairing the valve between the ureter and the bladder, but it's performed using small incisions. Preliminary findings suggest that robotic-assisted laparoscopic surgery has similar success rates to open surgery. It was also associated with a longer operating time, but a shorter hospital stay.
  • 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.

Lifestyle and home remedies

Urinary tract infections, which are so common to vesicoureteral reflux, can be painful. But you can take steps to ease your child's discomfort until antibiotics clear the infection. They include:

  • Encourage your child to drink fluids, particularly water. Drinking water dilutes urine and may help flush out bacteria.

    Avoid juices and soft drinks containing citrus and caffeine until your child's infection has cleared. They can irritate the bladder and tend to aggravate the frequent or urgent need to urinate.

  • Provide a warm blanket or towel. Place a towel or blanket in the dryer for a few minutes to warm it up. Be sure the towel or blanket is just warm, not hot, and then place it over your child's abdomen. The warmth can help minimize feelings of bladder pressure or pain.

Preparing for your appointment

Doctors usually discover vesicoureteral reflux as part of follow-up testing when an infant or young child is diagnosed with a urinary tract infection. If your child has signs and symptoms, such as pain or burning during urination or a persistent, unexplained fever, call your child's doctor.

After evaluation, your child may be referred to a doctor who specializes in urinary tract conditions (urologist).

Here's some information to help you get ready, and what to expect from your child's doctor.

What you can do

Before your appointment, take time to write down key information, including:

  • Signs and symptoms your child has been experiencing, and for how long.
  • Information about your child's medical history, including other recent health problems.
  • Details about your family's medical history, including whether any of your child's first-degree relatives — such as a parent or sibling — have been diagnosed with vesicoureteral reflux.
  • Names and dosages of any prescription and over-the-counter medications that your child is taking.
  • Questions to ask your doctor.

For vesicoureteral reflux, some basic questions to ask your child's doctor include:

  • What is likely causing my child's signs and symptoms?
  • Is it a bladder or kidney infection?
  • Are there other possible causes for these symptoms?
  • What kinds of tests does my child need?
  • How likely is it that my child's condition will resolve without treatment?
  • What are the benefits and risks of the recommended treatment in my child's case?
  • Is my child at risk of complications from this condition?
  • How will you monitor my child's health over time?
  • What steps can I take to reduce my child's risk of future urinary tract infections?
  • Are my other children at increased risk of this condition?
  • Do you recommend that my child see a specialist?

Don't hesitate to ask questions that occur to you during your child's appointment. The best treatment option for vesicoureteral reflux — which can range from watchful waiting to surgery — often is not clear-cut. In order to arrive at a treatment decision that feels right to you and your child, it's important that you understand your child's condition and the benefits and risks of each available therapy.

What to expect from your doctor

Your child's doctor will perform a physical examination of your child. He or she is likely to ask you a number of questions as well. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

  • When did you first notice that your child was experiencing symptoms?
  • Have these symptoms been continuous or occasional?
  • How severe are your child's symptoms?
  • Does anything seem to improve these symptoms?
  • What, if anything, appears to worsen your child's symptoms?
  • Does anyone in your family have a history of vesicoureteral reflux?
  • Has your child had any growth problems?
  • What types of antibiotics has your child received for other infections, such as ear infections?
June 20, 2014
References
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  3. Vesicoureteral reflux. The Merck Manuals: The Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/pediatrics/congenital_renal_and_genitourinary_anomalies/vesicoureteral_reflux.html. Accessed April 1, 2014.
  4. Urinary tract infection in adults. National Kidney and Urologic Diseases Information Clearinghouse. http://www.kidney.niddk.nih.gov/kudiseases/pubs/utiadult/. Accessed April 1, 2014.
  5. Tekgul S, et al. EAU guidelines on vesicoureteral reflux in children. European Urology. 2012;62:534.
  6. Fever and your child. American Academy of Pediatrics. http://patiented.aap.org/content2.aspx?aid=5107. Accessed April 6, 2014.
  7. McLorie G, et al. Management of vesicoureteral reflux. http://www.uptodate.com/home. Accessed April 3, 2014.
  8. Castle EP (expert opinion). Mayo Clinic, Rochester, Minn. April 6, 2014.
  9. Schmitt BD. Pediatric Telephone Protocols. 14th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2013:120-124.
  10. McLorie G, et al. Presentation, diagnosis, and clinical course of vesicoureteral reflux. http://www.uptodate.com/home. Accessed April 30, 2014.