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. Management of VUR has been based upon the premise that VUR predisposes patients to acute pyelonephritis by transporting bacteria from the bladder to the kidney. Pyelonephritis itself is a morbid event that requires acute medical care and possible hospitalization in young infants. In addition, the resulting infection may lead to loss of renal parenchyma (renal scarring). However, there are inconclusive data comparing the effectiveness of an interventional versus an observational approach in improving long-term renal outcome As a result, there is controversy regarding the optimal management of patients with VUR.
The management of VUR will be reviewed here. The manifestations and diagnosis of VUR is discussed elsewhere in the program. (See "Clinical presentation, diagnosis, and course of primary vesicoureteral reflux".)
The use of therapeutic interventions in the management of vesicoureteral reflux (VUR) is based upon the following :
●Identification of children with VUR (see "Clinical presentation, diagnosis, and course of primary vesicoureteral reflux")
●Prevention of recurrent urinary tract infections (UTI)
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- THERAPEUTIC INTERVENTIONS
- Medical treatment
- - Complications
- Surgical treatment
- - Surgical reimplantation
- Open surgical reimplantation
- Robotic assisted laparoscopic reimplantation
- - Endoscopic correction
- Bladder and bowel dysfunction
- CHOICE OF THERAPY
- Antibiotic prophylaxis versus surveillance/placebo trials
- Medical versus surgical therapy
- OUR APPROACH
- Grades III to V
- Grade I and II
- Surveillance and medical therapy
- - Discontinuation of medical therapy
- Surgical therapy
- Long-term follow-up
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS