Treatment for VUR
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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.