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Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection and renal scarring or reflux nephropathy ( 1). For continued treatment improvement, better identification of children at risk of renal scarring, robust evidence regarding the available interventions, and an improved VUR grading system are needed. Over the last 20 years, there has been a shift toward more conservative management of VUR with an individualized, risk-based approach. Ureteral reimplantation is still performed commonly, and robot-assisted laparoscopic methods are gaining popularity. Long-term studies of endoscopic injection have helped us understand factors influencing use and the effectiveness of this procedure. Antibiotic prophylaxis can reduce the incidence of UTIs, but drawbacks such as antibiotic resistance and incomplete adherence mean that this option is not viable for long-term use. Observation is suitable only for patients at low risk of renal injury. There are several options for managing patients with VUR. Therefore, strategies to reduce clinicians' reliance upon VCUG (e.g., after a VUR treatment procedure) have been developed. However, this procedure causes distress and radiation exposure. Voiding cystourethrography (VCUG) is generally considered the definitive method for diagnosing VUR, and helpful in determining the need for treatment. Some factors that increase the likelihood of persistence (e.g., high grade) also increase the risk of renal scarring. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often involved. We review advancements over the last two decades in our understanding and management of VUR. Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. |
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