Vesicoureteral reflux: diagnosis and management

Vesicoureteral reflux is the retrograde passage of urine from the bladder into the ureter and kidneys during voiding. This commonly-treated entity is frequently managed by different disciplines that include Urology, Nephrology and Pediatrics. The pathophysiology of vesicoureteral reflux seems to be related to the valve mechanism of the ureterovesical junction. Abnormal location of the ureteral orifice is implicated in the short ureteral tunnel which in turn compromised the flap-valve mechanism. The grading of reflux is important since management depends on the severity according to a five grade system. At present, medical management using antibiotic prophylaxis has become well established for managing patients with low-grade reflux (grades I-III). Moderate reflux (grade III-IV) could be managed by surgery in case of breakthrough infections. Recommendations regarding the diagnosis and medical management remain complex and are continuously evolving. More frequently than not, treating pediatricians and urologists would have to make decisions by individualizing each patient and considering the likelihood that patient's reflux will resolve.