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Surgical Treatment of Vesicoureteral Reflux in Children

Endoscopic, laparoscopic, robotic, and open surgical approaches for moderate to severe vesicoureteral reflux (VUR) in children, indicated when conservative management or continuous antibiotic prophylaxis fails to prevent breakthrough urinary tract infections or progressive renal damage.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Çocuk Sağlığı ve Hastalıkları department. Book Appointment →

What is Surgical Treatment of Vesicoureteral Reflux in Children?

Vesicoureteral reflux (VUR) is the retrograde flow of urine from the bladder into the ureter and renal pelvis, predisposing children to recurrent pyelonephritis and progressive renal scarring; international guidelines grade reflux from I (limited to ureter) to V (massive dilation with tortuous ureter).

Indications for surgery include breakthrough febrile urinary tract infections on continuous antibiotic prophylaxis, persistent high-grade reflux, progressive renal scarring on dimercaptosuccinic acid scan, lower urinary tract dysfunction unresponsive to therapy, and parental or patient preference for definitive correction.

Surgical options include endoscopic subureteric injection (e.g., dextranomer/hyaluronic acid; success ~70 to 80 percent for low to moderate grades), open extravesical or intravesical reimplantation (Cohen, Politano-Leadbetter; success >95 percent), and laparoscopic or robotic-assisted ureteral reimplantation in higher-volume centers.

Symptoms

Recurrent febrile urinary tract infections (pyelonephritis) in a child with confirmed VUR
Antenatal hydronephrosis with postnatally confirmed high-grade reflux
New or progressive renal scarring on follow-up dimercaptosuccinic acid scan
Lower urinary tract dysfunction with associated reflux unresponsive to behavioral therapy
Persistent high-grade reflux (grade IV to V) beyond 5 years of age
Parental or patient preference for definitive surgical correction

Risk Factors

High-grade reflux (grade IV to V) in male infants and toddlers
Bilateral high-grade reflux with renal scarring
Voiding dysfunction or bowel-bladder dysfunction with VUR
Family history of VUR or congenital anomalies of the kidneys and urinary tract (CAKUT)
Renal scarring on initial dimercaptosuccinic acid scan or congenital small kidney
Recurrent breakthrough infections despite continuous antibiotic prophylaxis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent febrile urinary tract infections in a child — referral to pediatric urology and nephrology for evaluation and consideration of surgery
  • Confirmed high-grade VUR with new renal scarring on dimercaptosuccinic acid scan
  • Antenatal hydronephrosis with postnatal high-grade reflux and persistent dilation
  • Lower urinary tract symptoms with VUR unresponsive to behavioral or medical therapy
  • Surgical complications: persistent reflux after correction, ureteral obstruction, hematuria, or new urinary symptoms

Treatment Methods

01
Diagnostic confirmation with voiding cystourethrogram, ultrasound, and dimercaptosuccinic acid scan to grade reflux and assess renal function
02
Endoscopic subureteric injection of dextranomer/hyaluronic acid copolymer for selected grade I to III reflux, performed as a day-case procedure
03
Open ureteral reimplantation (Cohen cross-trigonal or Politano-Leadbetter) for high-grade or complex VUR with success rates greater than 95 percent
04
Laparoscopic or robotic-assisted ureteral reimplantation (extravesical or Glenn-Anderson) in experienced centers, with shorter hospital stay and good cosmetic outcomes
05
Multidisciplinary follow-up: postoperative imaging, renal function monitoring, treatment of bowel-bladder dysfunction, and continued surveillance for breakthrough infections and renal scarring

Which Department to Visit?

You can visit our Çocuk Sağlığı ve Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Çocuk Sağlığı ve Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.