The treatment depends on the grade of VUR (how severe it is). Many children grow out of VUR, and treatment may only be needed for their early years before they go to school.
Where will my child be treated?
If your baby or child has VUR, he or she may be referred to a paediatrician, a doctor who treats babies, children and young people.
Some babies and children with high-grade (severe) VUR or reflux nephropathy are referred to a paediatric urologist, a surgeon who treats children with problems of the urinary system. The urologist will assess your child and consider whether treatment is needed.
Occasionally, children are referred to a paediatric nephrologist, a doctor who treats children with kidney problems.
Preventing and treating urinary tract infections
Children with VUR and reflux nephropathy are at higher risk of urinary tract infections (UTIs), which may keep coming back (recurrent). In serious cases, these may affect their kidneys.
It is important to treat UTIs quickly when they do happen.
Preventing UTIs
Children with high-grade VUR may benefit from taking a small dose of antibiotic medicine once a day – this is called a prophylactic antibiotic. Antibiotics kill bacteria (germs) that cause UTIs, and so help prevent these infections.
Treating UTIs
Sometimes UTIs can happen even when your child is taking these antibiotics. It is important that UTIs are diagnosed and treated quickly to try to prevent them causing kidney damage. If you think your child has a UTI, contact your doctor or local NHS services.
It is important to follow your doctor’s instructions about when and how much to give. Continue to give the antibiotics to your baby as your doctor has told you.
Controlling blood pressure
It is important that your child’s blood pressure is in a healthy range, to help keep his or her kidneys healthy. If your child has high blood pressure (hypertension), he or she may need to change what he or she eats and drinks. Some children need to take medicines.
More about hypertension and how to control blood pressure
Reducing protein loss in urine
If your child’s urine tests show proteinuria (more protein in the urine than normal), he or she will need more tests. If the proteinuria persists or gets worse, your child may need medicines. These will try to reduce the amount of protein lost in their urine and so protect the kidneys.
Surgery – injecting a gel (Deflux® or other brands)
Surgery is rarely needed. However, if your child has high-grade (severe) VUR and recurrent UTIs (that keep coming back), your paediatric urologist may recommend surgery to correct the VUR. This aims to protect the kidneys from infections.
The first surgical procedure that is usually recommended is to inject a gel into the end of the ureter within the bladder. This narrows the space, preventing urine refluxing out of the bladder, without blocking urine flowing into the bladder. The gel used is usually one called Deflux®, though other gels may be used.
This is a quick procedure, and may be used for babies and children of any age. Your child can usually go home the same day.
Risks and complications
Serious complications are very rare. However, no procedure is completely safe, and it is important you understand the risks. Your urologist will speak with you about the possible problems before you consent (agree) to the procedure.
- Although rare, the gel can partially block urine flowing out of the kidney. This will be checked with an ultrasound scan a few weeks after the procedure.
- Occasionally, children get a urinary tract infection after the procedure, and will need to take antibiotics to treat the infection. Your child may be given a small dose of antibiotics to help prevent infection during the procedure, and for a short time afterwards.
- Some children have visible blood in their urine (haematuria) for a short time after the operation. This resolves (gets better) on its own.
- Although this procedure works in most children, there is a risk that the reflux may come back. It is possible to repeat the procedure a second or third time if necessary. If these repeat procedures also fail, the paediatric urologist may then recommend open surgery.
What happens
- A general anaesthetic is used to make your child go to sleep so he or she does not feel pain anywhere in his or her body. General anaesthetic may be given as a gas that your child will breathe in or it may be injected into a blood vessel. You will see an anaesthetist (a specialist doctor who is trained in giving these medicines) before the procedure.
- A cystoscope (like a tiny telescope) is covered with a special gel, and gently passed through your child’s urethra and into the bladder.
- Sterile (completely clean) water is pumped through the cystoscope, so that the urologist can see inside the bladder using the camera and then inject the gel.
After treatment
- Your baby or child will stay in hospital until they are feeding or eating well and passing urine normally. He or she can normally go home the same or next day.
- Your baby or child may need to take antibiotic medicines to prevent or treat any infection caused by the cystoscopy.
Ureteric reimplantation
Very occasionally, another operation called ureteric reimplantation is recommended. This procedure re-tunnels the ureter into the bladder to create an anti-reflux mechanism – as should normally happen.
The urologist makes a cut at the bottom of your child’s abdomen (tummy), and tunnels the ureter through the bladder wall. A thin flexible tube called a catheter is placed through the urethra to drain urine from the bladder. It is left in place for a few days until your child can pass urine on his or her own.
This surgery is also done under general anaesthesia, so your child can sleep through the procedure and not feel any pain.
Follow up
All children with VUR and reflux nephropathy need to go back to the clinic or hospital for more tests and to see the doctor. It is important that you go to these appointments even if your child seems well. They will check whether your child is getting better, or whether there is any damage to his or her kidneys.
After a while, your child will only have more tests if he or she has problems with urinary tract infections (UTIs) that keep coming back.
Preventing UTIs
Children with VUR and reflux nephropathy are at higher risk of UTIs. If your child is taking antibiotics once a day to prevent UTIs, it is important that you continue giving the medicines until your doctor tells you to stop. Speak with your doctor if you have any concerns.
If you think your child has a UTI, seek medical advice.
Reflux nephropathy on one kidney
If your child has scars on one kidney (unilateral reflux nephropathy), he or she has a higher risk of developing high blood pressure (hypertension) over time.
Your child will need long-term follow-up. This may include blood pressure measurements once a year.
Reflux nephropathy on both kidneys
If your child has scars on both kidneys (bilateral reflux nephropathy), he or she will need long-term follow up. This includes:
- blood pressure measurements
- urine tests to check for protein and other substances in his or her urine – if there is more protein than usual in the urine (proteinuria), this may be a sign of hyperfiltration, when there are fewer kidney filters working
- blood tests – to measure his or her kidney function (how well his or her kidneys are working).
Long-term effects
In many children, VUR will disappear as they grow. It is not known how many children continue to have VUR as they grow older, because most do not need regular tests.
Kidney problems
A very small number of children, especially those with high-grade (severe) VUR and/or bilateral reflux nephropathy, can progress to later stages of chronic kidney disease (CKD). Their kidneys gradually stop working properly – this usually happens slowly over many years. Many children with CKD do not have any problems until they reach puberty (teenage years), when they grow quickly.
If your child has CKD, you and your child will learn more on how to help manage the condition, and what to expect.
Further support
This can be a difficult and stressful experience for you and your family.
If you have any concerns or need additional support, speak with your doctor or nurse.