VUR grade 4

Understanding VUR grade 4 and its treatment options

What is VUR grade 4?

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


VUR grade 4 treatment options

There are basically four ways your child’s paediatric 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.

  1. Elder JS, Peters CA, Arant BS, et al. AUA pediatric vesicoureteral reflux clinical guidelines panel: The management of primary vesicoureteral reflux in children. American Urological Association Education and Research, Inc. 1997.
  2. Baskin LS, Kogan BA, Stock JA. Handbook of Pediatric Urology Third Edition. Philadelphia, PA: Wolters Kluwer; 2019.
  3. Peters CA, Skoog SJ, et al. Management and screening of primary vesicoureteral reflux in children: AUA guideline. American Urological Association Education and Research, Inc. Revised 2010, Validated 2017: 9-13.