Management of vesicoureteral reflux
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
- Saul P Greenfield, MD
Saul P Greenfield, MD
- Clinical Professor of Urology, State University of New York at Buffalo School of Medicine & Biomedical Sciences
- Director of Pediatric Urology, Children’s Hospital of Buffalo
- Section Editors
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- F Bruder Stapleton, MD
F Bruder Stapleton, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Nephrology
- Professor and Chair, Department of Pediatrics
- University of Washington School of Medicine
Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder into the upper urinary tract. The clinical significance of VUR has been based on the premise that it predisposes patients to acute pyelonephritis by transporting bacteria from the bladder to the kidney, which may lead to renal scarring, hypertension, and end-stage renal disease (ESRD). However, aspects of this long-held belief have been increasingly questioned. In addition, data are inconclusive regarding the effectiveness of therapeutic interventions on long-term renal outcome and recurrent UTI. As a result, there is controversy regarding the optimal management of patients with VUR.
The management of VUR will be reviewed here. The presentation, diagnosis, and clinical course of VUR are discussed elsewhere in the program. (See "Clinical presentation, diagnosis, and course of primary vesicoureteral reflux".)
Goal — The goals of VUR management include:
●Prevention of recurrent episodes of pyelonephritis and urinary tract infections (UTI)
●Prevention of further renal damage (eg, renal scarring)
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- - Bladder and bowel dysfunction
- - Grades III to V
- - Grade I and II
- THERAPEUTIC OPTIONS
- Watchful waiting (surveillance)
- Antibiotic prophylaxis
- - Indications
- - Agents and dosing
- - Discontinuation
- - Complications
- Surgical treatment
- - Indications
- - Procedures
- Open surgical reimplantation
- Robotic-assisted laparoscopic reimplantation
- - Endoscopic correction
- Surveillance and antibiotic prophylaxis
- - Discontinuation of medical therapy
- Surgical therapy
- Long-term follow-up
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS