Treatment of Vesicoureteral Reflux
Lower grades of reflux will often resolve on their own, typically at 5 to 6 years of age. The goal is to prevent UTIs and kidney damage while the reflux is improving.

Antibiotic prophylaxis: It has been the gold standard of care to keep children on a very low dose of antibiotics to inhibit the growth of bacteria (not to correct the VUR). This is called antibiotic prophylaxis. Antibiotics are continued until the risk of reflux is considered low.

Bathroom habits and fluid intake: If your child is toilet-trained, her bathroom habits are very important. We encourage your child to empty her bladder every two to three hours, without holding. We assess for any signs of constipation which can contribute to the occurrence of a UTI. We also ask your child to increase the amount of water she drinks. All of these steps can help reduce the risk of bacteria growing in your child’s urine.

Surgical intervention: Children who have grade 4 and 5 reflux or who have had repeated UTIs with concerns of kidney scarring, may require surgical intervention to fix the reflux.

Surgical options
Many factors should be considered when deciding about what treatment is best for your child: the severity of the reflux, whether the reflux is in one or both ureters, your child’s age and gender and the presence of kidney damage. We will thoroughly discuss all options with you and your child.

Endoscopic surgery: This is usually an outpatient procedure under general anesthesia. During surgery a lighted tube, called a cystoscope, is inserted into the urethral opening to see inside the bladder - no incisions are made. A substance, called Deflux?, is injected into the area where the ureter enters the bladder. Deflux helps prevent urine from flowing back into the ureter.

Ureteral reimplant: Under general anesthesia and through a lower abdominal incision, the ureter is reimplanted where it joins the bladder. Ureteral reimplantation corrects the anatomical abnormality that allows urine to flow back into the ureter. At CHOP this procedure can be done through a minimally invasive surgery (MIS) using a laparoscopic or robotic approach. This involves only a few small incisions instead of a larger lower abdominal incision. The benefits of MIS include a faster recovery, smaller incisions and a less noticeable scar. Most children go home the day after surgery.