Vesicoureteral reflux

Abstract

Primary aims in the diagnosis and management of vesicoureteral reflux (VUR): 1. Reduce recurrent febrile urinary tract infection (fUTI). 2. Prevent acquired renal damage. Summary of evidence for these aims: Children with VUR have been assumed to have high risk for renal scarring and recurrent fUTI, justifying therapy in most patients. However: RCTs indicate only approximately one-third of patients with VUR will have recurrent UTI within 2 years of diagnosis Acquired renal scarring occurs in approximately 15 % of children with VUR after fUTI. If DMSA scan for renal scar is negative, risk subsequent fUTI will cause renal damage is ≤10 %. No randomized controlled trial (RCT) has been done to determine if VUR therapy (medical or surgical) decreases additional acquired renal damage in children with renal scar at presentation. Antibiotic prophylaxis is no more effective than placebo to prevent recurrent UTI in children 1-24 months of age with grades 1-4 VUR. There are no data regarding benefit of antibiotic prophylaxis in children >2 years of age with VUR, with VUR and no history of UTI, with grade 5 VUR, or with recurrent UTI. Surgical correction of VUR (reimplantation or endoscopic injection) reduces recurrent fUTI. Identification and treatment of voiding dysfunction in children with VUR has not been clearly demonstrated to improve resolution or reduce fUTI.