Treatment for VUR

Please visit our new site www.kidneyreflux.info for updated articles and information on Reflux.

This is where the argument begins. How do you treat VUR? For the purpose of this “article” I am going to talk about the most commonly accepted treatment methods. This DOES NOT mean that I agree with them. They are widely debated. My personal opinion and experience will come in another article.

Treatment for VUR is based on the grade of reflux. After diagnosis, the child is usually started on a prophylactic antibiotic, which is a daily, low dose of antibiotic. The hope is that the abx will kill any bacteria before they can cause an infection. There is a lot of debate as to whether this approach is effective.

For grades 1-3, the child is given daily abx, and then monitored for any changes. Since about 80% of children in this group have spontaneous resolution, there may be no need for any other treatment.

In grades 4-5, (sometimes 3 is included), abx are also started, and the child is monitored. In the higher grades, spontaneous resolution is much less likely. For these children, Deflux injection, or reimplantation surgery may be required if the VUR does not resolve on it’s own, or if there are problems with breakthrough UTIs.

There is a lot of debate on the treatment of VUR, but the overall goal is always to keep the kidneys healthy. From my experience and research, most urologists start a child on abx regardless of the grade. For all grades, most wait to give the child time to grow in hopes of resolution. A VCUG is performed yearly to monitor the child’s condition. When there are breakthrough infections, most will take an aggressive approach to correct the VUR. Deflux is generally used for the lower grades, and the higher grades require reimplantation.

Deflux is generally around 80% successful, but may need to be repeated. Reimplantation has a 95% or better success rate. You should discuss your options in detail with your urologist, and do your own research. Check out our links page to get some good articles!

For the very small percentage of failed reimplantation surgeries (of which Lizzie is a part), the child should undergo urodynamics study to rule out abnormalities in the bladder which may be causing the VUR. An MRI might also be a good option to rule out any neurologic problems which might be causing the VUR. Lizzie has done both of these tests in the past few months, and both have given us a great deal of information.

5 Comments

  1. alina said,

    hi,

    My son is 4years old and has bilateral VUR. One side grade 3 and the other grade 2. When he was born he was grade 5 on both sides. He has never had any uti’s but his doctor still recommends surgery. He says bilateral VUR has a less chance of resolving on its own. I wanted to know if this is true, if both sides are affected does this mean he will not grow out of it. He has also been constipated since he was born and see’s a gastroenterologist for treatment.

    I feel so hopeless, and need some answers.

    The urologist we saw is one of the best in nyc.

    • workjw said,

      Hello! Your doctor is correct that high grade bilateral VUR is less likely to resolve, however it’s not impossible. It sounds like your son’s VUR has decreased over the years, and that accompanied with no UTI’s is really good news! Our urologist originally said that if our daughter’s VUR had not resolved by the age of 5 that we would consider surgery. Unfortunately we weren’t able to wait that long. Is your doctor recommending a ureteral reimplantation or a Deflux procedure? With grades 3/2 I might consider Deflux rather than open surgery especially considering he has had no UTI’s. The Deflux procedure is much less invasive, and is an outpatient procedure. Have you had a second opinion? Most insurance companies welcome a second opinion before surgery to ensure that the procedure is needed.

      I completely understand that feeling of hopelessness, it’s very difficult to make such tough decisions about our kiddos. There are a lot of great parents on our message board http://kidneyreflux.info/forum/viewforum.php?f=3 whose children have been through similar issues. Please feel free to join in the discussions! It’s been really helpful for me just to be able to talk to other parents that understand. Good luck with your decision!

  2. Collyn said,

    Hi,
    My son is 61/2 and has moderate to severe reflux on the left side. They can’t give me a number because he had an NVCUG. He had hydronephrosis as an infant and his vcug at 2 months was neg. He got sick last year with a possible uti. It wasn’t definitely a UTI. He had a NVCUG with an active infection and it said he had moderate reflux. Last week he had another NVCUG and it has gotten a little worse. Now the doctor is saying to have deflux done. I’m concerned that -1 it won’t work and we will have to do surgery and -2 if a failed deflux would complicate a future surgery. Any thoughts. Also, ideas on questions to ask the Doctor.
    Thanks

    • workjw said,

      Hi Collyn! Sorry that I’m just getting back to you, I don’t check this board as often. The one good thing about Deflux is that it does not complicate future surgery, so in many cases, it’s worth trying first. The Deflux surgery is much less invasive, and is usually done as an outpatient procedure. As for whether or not it will work, that’s a little tougher. I think on average the success rate is around 80-85% on the first injection. It’s not as effective as the open surgery, but 85% is still a pretty high number. Of course a lot of it depends on the severity of reflux, and since you don’t know that for sure, it’s really hard to say. I would say that if he’s only had one possible infection, than your odds are probably increased that it will be effective.

      I’m not a doctor or healthcare professional, so it’s all just my opinion, but it might be worth trying. I would talk to the doctor about whether or not he would remain on abx (assuming he’s on daily abx now) and what your time line would be for re-testing. If it isn’t effective, does he want to try Deflux again, or go directly to reimplantation? (it’s often done up to 3 times before declaring it a failure)

      Good luck with everything! Keep us posted on what you decide. It’s a tough decision!

  3. Jennifer said,

    Hi!
    My 4 1/2 year old daughter was diagnosed with a grade 1 reflux when she was 11 months old. By the time she was 2 her reflux was 2 on one side and 3 on the other. It continues to stay the same with yearly VCUG’s and ultrasounds. In the last 4 months she has had 2 pretty serious breakthrough infections with 104 degree fevers and lethargic for days, but this is a typical reaction for an infection. With her las she developed hydronephrosis, which as of todays ultrasound has gone away. Apparently a side effect of infections sometimes. Her kidneys do not appear to be damaged from the ultrasound, but because of her last 2 breakthroughs and how sick she gets, her doctor would like us to think about surgery. He syas there is still a 50% chance she could outgrow this, but we don’t want to risk kidney damage or any more infections because of how sick she gets. She has been on antibiotics for the past 3 years. I’d appreciate any words of wisdom.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

%d bloggers like this: