Vesicoureteral reflux (VUR) is a pediatric condition that allows urine to flow backwards – from the bladder to the kidneys – through one or both of the connecting tubes (ureters). It is a condition that often co-exists with urinary tract infections (UTIs), although VUR is not caused by UTIs.
What are the symptoms of VUR?
The most common first-line treatment used for VUR is to put the child on antibiotics to prevent UTIs. Typically, this involves taking a low dose of antibiotics once or twice a day, every day. This is called antibiotic prophylaxis. With this treatment option, the urologist tries to protect the child from UTIs while waiting for the VUR to go away by itself.
It involves using an endoscope to facilitate the injection of material in or around the area where the ureter enters the bladder to repair the valve function and keep urine from refluxing back into the kidneys. The child is put under general anesthesia. An instrument called an endoscope is inserted into the urethra up into the bladder. The endoscope has a tiny camera on its tip as well as a channel to allow the passage of a needle to make the injection. The surgeon guides the tip of the endoscope to the right spot and injects the material. The procedure takes about 20 minutes.
Open surgery (Ureteric reimplantation) for VUR:
This involves placing the child under general anesthesia and surgically fixing the ureters to stop VUR. The procedure varies, but can take up to three hours and involves removing the ureter where it joins the bladder and reimplanting it at another spot on the bladder. In effect, the surgeon creates a new valve structure by reattaching the ureter and creating a new tunnel through the bladder wall. This corrects the anatomical abnormality causing the reflux
What are the pros and cons of open surgery?
The main advantage to surgery is its high success rate (88-99%). This procedure has been performed for many years and pediatric urologists have had great success with it. As with any surgical procedure there is a risk of infection and bleeding, however that risk is low. Surgery also usually requires a short hospital inpatient stay, and it can be stressful and uncomfortable for the child.