How to Treat Urinary Reflux in Children

Two Methods:Using Medical Management to Treat RefluxUsing Surgery to Treat Reflux

Urinary reflux is when urine flows back up into the ureters, the tubes that lead to the kidneys, because the valve that normally would keep this urine out is weak. If your child has been diagnosed with urinary reflux, consider working with a doctor to manage your child’s reflux before considering surgery.

Method 1
Using Medical Management to Treat Reflux

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    Observe and carefully monitor your child’s health. Lower grades of reflux resolve without surgery in most children. This usually occurs as the bladder and its ureteral valve undergo growth.
    • If children with lower grades remain free of recurring infections, new kidney injury is uncommon.
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    Be aware of the chances that each grade of reflux has of resolving without surgery. The chance of the reflux resolving depends somewhat on how old your child is when he or she is diagnosed. The longer the child has had reflux, the less likely that it will resolve on its own. The intensity of the reflux is described as a ‘grade’, with grade 1 being the least intense, and most likely to resolve without surgery [1] The overall likelihood of the reflux eventually resolving without surgery is roughly:
    • Grade 1: 80 to 90%.
    • Grade 2: 70 to 80%.
    • Grade 3: 50 to 60%.
    • Grade 4: 10 to 20%.
    • Grade 5: 5 to 10%.
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    Determine if dysfunctional voiding is a part of the problem. Voiding dysfunction refers to several common conditions in which children have abnormal urination patterns with and without moderate to severe constipation. Some common signs that your child is dealing with dysfunctional voiding include:
    • Frequent urination with urgent running to the bathroom or daytime wetting.
    • Urination may be infrequent, perhaps two to three times a day or less.
    • Keep in mind that parents may be unaware of constipation if their child does not recognize or admit to it.
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    Treat the dysfunctional voiding to combat the reflux. Treatment of voiding dysfunction usually requires some combination of bladder retraining, behavior modification, medications, and pelvic floor biofeedback therapy. Most large pediatric medical institutions have specialists or programs that can assist in developing a treatment program specifically for your child.
    • You can also read about treatments for voiding dysfunction here.
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    Understand that urinary tract infections (UTIs) are also a condition that can lead to reflux. Children, mostly girls, with dysfunctional voiding are prone to recurrent UTIs. In general, after age one, girls have UTIs more frequently than boys.The risk of a girl getting a UTI, in general, can be diminished by good hygiene in the genital area (keeping clean and dry, wiping front to back, and wearing cotton underwear all help), and drinking enough water to void a dilute urine 5 to 7 times a day. Common symptoms of UTIs include[2]:
    • A burning sensation when urinating.
    • Unusual-smelling urine.
    • Fever.
    • Nausea, vomiting, and diarrhea.
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    Treat your child’s UTI with antibiotics. When a UTI is suspected, an antibiotic with broad effectiveness against most of the usual bacteria is selected until the urine culture result is available (urine cultures will be discussed in the next step). The usually takes 24 to 48 hours.
    • Most uncomplicated UTIs in children are treated for about 7 days. For more serious infections, treatment should be for 10 to 14 days or more.
    • Common antibiotics include: Amoxicillin, Trimethoprim, sulfamethoxazole, and Nitrofurantoin.
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    Have a culture taken to determine if your child really has a UTI. Take your child to a doctor to have a culture taken to see if the child has bad bacteria, which can cause the infection, in his or her urinary tract. The culture may take a few days to a week to be processed.
    • If the culture is negative, any antibiotic treatment can be discontinued.
    • If the culture is positive, the choice of antibiotic may be changed to select the one with the most specific effectiveness. Your provider will receive this information with the urine culture result.
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    Talk to your doctor about continuous antibiotics to treat recurrent UTIs. Children with frequent UTIs, especially those with reflux, can receive long-term (months to years) treatment with “low dose” antibiotics; this is called antibiotic prophylaxis. The rationale is that daily small doses of antibiotics will “suppress” bacterial growth in the urine and prevent the UTI from developing.
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    Schedule regular sonogram appointments for your child. During observation or medical management, periodic kidney and bladder sonograms can document normal kidney growth and can make sure that no new kidney scars have formed. If the sonogram is not sufficient or inconclusive, a kidney scan test called a DMSA renal scan has a very high sensitivity for kidney scars.[3]

Method 2
Using Surgery to Treat Reflux

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    Talk to your child’s doctor about surgical correction. The main goals of treatment are to preserve normal kidney growth, prevent progressive kidney scars, and avoid recurrences of serious kidney-related infections. When the effectiveness of medical management is compared to surgery in the general reflux child population, there are no great differences between the two in reaching these goals. However, in those whose medical therapy fails to prevent these reflux-related consequences, surgery is considered.
    • There are two basic methods to surgically correct reflux: minimally invasive endoscopic treatment and surgical repair.
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    Consider using endoscopy to treat your child. Bladder endoscopy is performed using a cystoscope (cystoscopy). The cystoscope is a thin, flexible, lighted telescope-like tube that enables the surgeon to look into the bladder and perform some tasks like tissue sampling and injections. The endoscopic procedure for reflux is often referred to as Deflux, which is the name of the material used to eliminate the reflux.[4]
    • The Deflux procedure is done through the cystoscope. Deflux is a viscous biodegradable gel. No actual surgical incision is required for this procedure. Using the cystoscope, the surgeon injects Deflux to create a bulge just below or within the urethra where it enters the bladder. The bulge reduces the size of the opening, allowing it to close during bladder contraction to eliminate reflux.
    • After the procedure, the urine may be light pink for a while and your child may have some discomfort when urinating for about a day. Acetaminophen can be used for the pain—follow the dose instructions on the package since this comes in many strengths.
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    Consider open surgery as a treatment for high-grade reflux. Open surgery for reflux is a treatment choice for high-grade reflux, particularly when the reflux is associated with more extensive abnormalities of the ureter or bladder.
    • Your child will be hospitalized following the procedure and pain management provided. This open surgery is much like any other procedure, but should be less painful. If everything goes well, your child should then be released from the hospital if she is eating, drinking, and urinating without problems.
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    Know that laparoscopic surgery is less frequently used in children. Laparoscopic surgery also has been used in this setting, but the frequency of unsatisfactory results or complications is higher than open surgery.


  • Children who undergo surgical correction of urinary reflux but continue to have dysfunctional voiding are more likely still have recurring UTI and even recurrence of the reflux.


  • Children with UTI and fever who appear particularly ill or are vomiting, and those

younger than 12 months often require initial treatment intravenously. Prompt initiation of treatment for UTI with fever (presumed pyelonephritis) is important. Those with delayed treatment (more than 48 hours) have a greater risk of developing kidney scars.

Sources and Citations

  3. Estrade CR. Passerotti CC, Graham DA et al. Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2,462 children. J Urol 2009;182:1535-41.
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Categories: Urinary Health | Childhood Health