Recent Advances in Paediatric Vesicoureteral Reflux: Risk Assessment and Management Strategies

Recent advances in paediatric vesicoureteral reflux (VUR) have focused on risk-stratification models to better identify patients at risk for complications such as renal scarring, persistent VUR, or breakthrough urinary tract infections (UTIs). By addressing critical clinical questions-such as predicting VUR presence, assessing the likelihood of spontaneous resolution, and determining the risk of breakthrough UTIs despite antibiotic prophylaxis-these tools enhance decision-making. Predictive models like the VURx score and ureteral diameter ratio integrate clinical, demographic, and imaging data to provide personalised risk assessments. Additionally, machine-learning techniques have advanced predictive accuracy by analysing complex interactions among risk factors, enabling tailored treatment plans. These stratification methods help clinicians minimise unnecessary procedures whilst ensuring early intervention for high-risk patients. In terms of management, continuous antibiotic prophylaxis (CAP) remains a common strategy for preventing UTIs in children with VUR. Guidelines from the American Urological Association (AUA) and European Society for Paediatric Urology (ESPU) emphasise a risk-based approach, recommending CAP primarily for high-risk patients. Alternatives to CAP include behavioural interventions, such as managing constipation and encouraging regular voiding, to reduce UTI recurrence. They should be considered as the initial step for all patients with suspected VUR. For patients with persistent reflux or recurrent UTIs despite conservative measures, surgical options, including endoscopic injection or ureteral reimplantation, offer effective solutions to mitigate long-term complications.