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Primary vesicoureteral reflux
Prem Puri1, Florian Friedmacher2, Marie-Klaire Farrugia3,4
1University College Dublin, Dublin, Ireland. prof.prempuri@gmail.com.
Nature Reviews. Disease Primers
|October 10, 2024
Summary
Primary vesicoureteral reflux (VUR) is a common condition in children. Management focuses on preventing urinary tract infections (UTIs) and kidney damage, with options ranging from observation to surgery.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Technology
Background:
- Primary vesicoureteral reflux (VUR) is a frequent urological condition in infants and children.
- VUR is linked to urinary tract infections (UTIs) and can lead to renal parenchymal damage, hypertension, proteinuria, and chronic kidney disease.
Purpose of the Study:
- To review the current understanding of VUR's natural history and identify at-risk patients.
- To outline the primary goals of managing pediatric VUR, focusing on UTI prevention and minimizing renal injury.
- To discuss current management options and ongoing debates in diagnosis and treatment.
Main Methods:
- Review of the natural history of VUR.
- Analysis of established associations between VUR, UTIs, and renal damage.
- Discussion of current treatment modalities: surveillance, antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation.
- Exploration of emerging technologies like artificial intelligence in VUR management.
Main Results:
- Improved understanding of VUR natural history aids in identifying at-risk children.
- Four primary management options exist: surveillance, continuous antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation.
- Key debates involve diagnostic imaging timing and patient selection for prophylaxis or surgery.
Conclusions:
- Effective management of pediatric VUR aims to prevent recurrent UTIs and long-term renal impairment.
- Current treatment strategies are evolving, with ongoing discussions on optimal diagnostic and therapeutic approaches.
- Future advancements, including AI, may personalize VUR diagnosis and treatment for improved outcomes.
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