[Primary vesicoureteral reflux in childhood : Diagnostics, risk stratification and treatment]

Area of Science:

• Pediatric Urology
• Congenital Urological Abnormalities

Background:

• Primary vesicoureteral reflux (VUR) is a frequent pediatric urological condition.
• It stems from congenital insufficiency of the valve mechanism due to a shortened submucosal ureter.
• This anatomical defect causes retrograde urine flow, increasing risks of febrile urinary tract infections (UTI) and renal scarring.

Purpose of the Study:

• To outline the classification, diagnostics, and treatment strategies for primary VUR in children.
• To emphasize the importance of preventing renal scarring and dysfunction.
• To discuss the risk-adapted conservative and surgical management options.

Main Methods:

• Classification of VUR severity according to the International Reflux Study Group.
• Diagnostic approach involving basic evaluations and instrumental reflux testing post-risk stratification.
• Review of current treatment strategies, including conservative management and surgical interventions.

Main Results:

• Low-grade VUR often resolves spontaneously, supporting a risk-adapted conservative treatment strategy.
• Antibacterial prophylaxis is considered for specific pediatric cases.
• Surgical options (endoscopic, laparoscopic/robotic-assisted, open) are reserved for severe or refractory VUR.

Conclusions:

• Primary VUR requires careful diagnosis and risk stratification.
• Conservative management is the standard for low-grade VUR, aiming for spontaneous resolution.
• Prompt intervention, including surgery, is crucial for severe or persistent cases to preserve renal function.