Vesicoureteral Reflux

Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder to the upper urinary tract. VUR affects about one percent of all children in the United States, and is typically diagnosed after repeated urinary tract infections (UTIs). Children with VUR may also have constipation and/or fecal soiling problems, and problems urinating normally.

Girls are twice as likely as boys to develop VUR, but boys are often diagnosed earlier. They usually have more severe reflux when they are diagnosed and are more likely to have generalized kidney damage. Girls have a high risk of dysfunctional urination and recurrent urinary tract infections.

Children with VUR are prone to kidney infections because the backward flow of urine can move bacteria from the bladder to the upper urinary tract. Some doctors believe that the immunological and inflammatory reactions that result from the infections can cause permanent kidney injury and scarring. VUR also is associated with difficulties during pregnancy in women who had VUR during childhood. The risk of complications increases the earlier VUR is diagnosed. About 30 percent of patients have evidence of renal scarring at that time.

Types of Vesicoureteral Reflux

Doctors describe VUR as primary or secondary. Primary reflux is reflux in an otherwise normal lower urinary tract. Secondary VUR is most often associated with an obstruction in the tract or with problems urinating.

Management of Vesicoureteral Reflux

In treating VUR doctors aim to prevent kidney infections and long-term complications such as renal scarring and failure. Specific treatment recommendations are based on the grade and severity of reflux. Treatment options include those listed below.

Medical Management with Long-Term Antibiotic Prophylaxis

This approach is recommended by the American Academy of Pediatrics, the American Urologic Association, and the Swedish Medical Research Council, but these groups all acknowledge that antibiotic prophylaxis is not supported by well-designed, randomized clinical trials.

Conventional Open Surgery or Minimally Invasive Endoscopic Surgery

In children whose reflux does not resolve over time, doctors may decide that surgical correction is necessary. There are two surgical options:

• Conventional Open Surgery: This is the most effective method to eradicate reflux. However, open surgery entails general anesthesia, a hospital stay, and leaves the child with an abdominal incision.
• Minimally Invasive Endoscopic Surgery: The pediatric urologists at NewYork-Presbyterian/Morgan Stanley Children's Hospital can also treat some cases of VUR with a less invasive, endoscopic procedure in which they inject a material called Deflux, a sugar-based gel, around the ureter opening. The gel creates a valve-like formation that allows urine to flow from the ureter into the bladder, but prevents it from flowing back up the ureter. Columbia's pediatric urologists have been at the forefront of endoscopic treatment of VUR with Deflux in the United States. Deflux has been shown to be both safe and effective, and this approach is increasingly popular and has gained FDA approval. Our experience in treating VUR is extremely broad and we have published a number of studies on endoscopic treatment of VUR.