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Published on: April 4, 2025
[Vesico-ureteral reflux: Diagnosis and treatment recommendations]
J Straub1, M Apfelbeck2, A Karl2
1Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland. julia.straub@med.uni-muenchen.de.
Insights
Vesico-ureteral reflux (VUR) in children often resolves on its own. Treatment focuses on preventing kidney damage, with decisions based on individual risk factors and parental input.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
Background:
- Vesico-ureteral reflux (VUR) is a common childhood urologic condition, frequently associated with urinary tract infections (UTIs).
- Diagnosis is confirmed by detecting urine backflow into the ureters or kidneys, sometimes aided by a positioned instillation of contrast agent (PIC) cystogram.
Purpose of the Study:
- To outline management strategies for VUR in infants, emphasizing the high likelihood of spontaneous resolution for low-grade cases.
- To highlight the primary goal of VUR treatment: preventing renal damage.
Main Methods:
- Assessing individual risk of renal scarring based on reflux grade, patient age, gender, and parental adherence.
- Considering conservative management, including prophylactic antibiotics for the first year, alongside surgical options (endoscopic or open).
Main Results:
- Low-grade VUR has a significant probability of self-limitation, particularly in infants.
- Prophylactic antibiotics are recommended for the first year, with reevaluation after 12 months.
Conclusions:
- Treatment decisions for VUR must be individualized, involving parents and considering all available clinical findings.
- Preventing renal scarring is the paramount objective in managing pediatric VUR.
Background:
Vesico-ureteral reflux (VUR) is one of the most common urologic diseases in childhood. About every third child that presents with a urinary tract infection (UTI) has urinary reflux to the ureter or kidney. Demonstration of a backflow of urine into the ureters or kidneys proves vesicoureteral reflux. In unclear cases, a positioned instillation of contrast agent (PIC) cystogram might be performed and is able to prove vesico-ureteral reflux.
Objectives:
Since low-grade VUR has a high probability of maturation and self-limitation, infants with VUR should be given prophylactic antibiotics during their first year of life, reevaluating the status of VUR after 12 months. The aim of any treatment is to prevent renal damage.
Therapy:
The individual risk of renal scarring is decisive for the choice of adequate therapy. This risk is mainly dependent on reflux grade, age, and gender of the child as well as parental therapy adherence. In principle, therapeutic options include conservative as well as endoscopic or open surgical antireflux therapies.
Conclusion:
Decisions on treatment should be made individually with parents taking into account all the findings available.
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