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Diagnosis and management of vesicoureteral reflux in children

Christopher S Cooper1

  • 1Department of Urology, University of Iowa, Iowa City, IA 52242-1089, USA. christopher-cooper@uiowa.edu

Nature Reviews. Urology
|August 12, 2009
PubMed

Insights

Current vesicoureteral reflux (VUR) management is questioned, particularly antibiotic prophylaxis and surgical intervention. Individualized VUR care based on risk factors is the emerging standard.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Infectious Disease

Background:

  • Traditional management of vesicoureteral reflux (VUR) included routine antibiotic prophylaxis and surgical intervention.
  • Recent critical evaluations challenge the established dogma of VUR treatment.
  • Uncertainty exists regarding the true benefit of antibiotic prophylaxis and the indications for surgical correction.

Purpose of the Study:

  • To critically evaluate current management strategies for vesicoureteral reflux (VUR).
  • To identify which children with VUR may benefit from antibiotic prophylaxis or surgical intervention.
  • To explore future research directions for optimizing VUR care.

Main Methods:

  • Review of existing literature and clinical practice regarding VUR evaluation and treatment.
  • Analysis of long-term follow-up data for endoscopic therapy and ureteroneocystostomy.
  • Proposal for prospective studies and retrospective reviews to identify risk factors.

Main Results:

  • The necessity and efficacy of antibiotic prophylaxis for VUR are now questionable.
  • Operative intervention may represent overtreatment for many children with VUR.
  • Endoscopic therapy shows decreased efficacy with longer follow-up compared to historical expectations.

Conclusions:

  • Current VUR management requires re-evaluation, moving towards individualized care.
  • Prospective studies are needed to identify risk factors for pyelonephritis and renal scarring without prophylaxis.
  • Retrospective analysis of adults with reflux history can help characterize childhood risk factors for adverse outcomes.

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