VUR grade 4 is similar to grade 3 where urine travels all the way up the ureter and enters the part of the kidney where urine is collected before it drains to the ureter (renal pelvis). However, in grade 4 the ureter is grossly enlarged.
The likelihood of spontaneous resolution varies according to a child’s age, grade of VUR, and whether the VUR is on one ureter or both.
VUR Resolution Chart – Percent Chance of Reflux Resolution After A Specified Number of Years1
American Urological Association
| 1 Year | 2 Years | 3 Years | 4 Years | 5 Years | |
| Grade 4 – One Ureter | 16.1% | 29.7% | 41.0% | 50.5% | 58.5% |
| Grade 4- Both Ureters | 4.5% | 6.4% | 7.8% | 8.9% | 9.9% |
More severe grades of reflux are associated with lower rates of spontaneous resolution and a higher incidence of renal scarring.2
There are basically four ways your child’s pediatric urologist or doctor may decide to treat your child, depending on the severity of your child’s VUR. The higher the grade, the more likely that treatment is needed. Your VUR grade 4 treatment options are watchful waiting, antibiotics, endoscopic treatment with Deflux, or surgery.3
Deflux is indicated for the treatment of children with VUR grades 2-4.
