Monitoring Children with Vesicoureteral Reflux

Vesicoureteral reflux (VUR) occurs when there is a backward flow of urine from the bladder to the ureters. It may be primary or secondary and is mostly seen in the pediatric population.

Signs and symptoms vary depending on the age of the child and may include failure to thrive, diarrhea, vomiting, anorexia, lethargy, vague abdominal pain and fever.

Diagnosis is made on the basis of laboratory findings and imaging as well as urodynamic studies.

Treatment considerations vary depending on the severity of the VUR, but may include surveillance, life style alterations, medical therapy and/ or surgery.

During Surveillance

Spontaneous resolution of VUR is not unusual as a child grows. Owing to this phenomenon, most authorities suggest monitoring the condition if the VUR is not severe or associated with any pathology that can cause significant morbidity and mortality.

The prediction of spontaneous resolution is made on the grounds of age, gender, anamnesis of urinary tract infections (UTIs) and laterality.

These children may or may not be given prophylactic antibiotic therapy and they are followed on an annual basis with diagnostic tests (such as urine analysis and imaging studies) to ascertain improvement and rule out worsening of the condition.

In the absence of serious complications, children with acute UTIs may be managed and monitored on an outpatient basis at home.

Parents are advised to encourage these children to drink as many fluids as possible, preferably water, while on antibiotic therapy. This encourages the flushing out of bacteria from the urinary tracts.

In the presence of serious complications and a toxic state, children are hospitalized, especially if they have developed pyelonephritis, which may be life threatening.

Parents are advised to increase and monitor the fiber content in their child’s diet, because this reduces the incidence of constipation, which often accompanies recurrent UTs.

Post-Operative Monitoring

Children may be hospitalized for a few days following the surgical correction of the malformation that was causing their VUR.

Post-operatively, children are seen a few weeks after discharge for a follow-up with their physicians. Several imaging modalities may be employed to ascertain the success of the surgical procedure (e.g. ultrasonography of the kidneys, ureters and bladder).

If these show acceptable results, then the patient is seen again within a few months, usually within six months.

At this time, further imaging tests may be conducted, with the help of a contrast agent or radioisotopes, if there are any doubts about the success of the surgical therapy.

As with all surgical procedures, there are risks and complications involved. Therefore, children need to be monitored post-operatively for complications.

A specific complication of VUR corrective surgery is upper urinary tract obstruction, which can manifest a few days postoperatively and requires surgical revision to clear the obstruction.

Unfortunately, for a small number of patients, surgery may be unsuccessful and the signs or symptoms of VUR may persist.

These patients will require surgical revision in another attempt to correct the problem.

Fortunately, a large majority of patients with postoperative persistent VUR go on to experience spontaneous resolution of VUR within a year.

Reviewed by Liji Thomas, MD.

References

Further Reading

Last Updated: Aug 29, 2017

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