RESEARCH ARTICLE


The Diagnosis and Treatment of Vesicoureteral Reflux: An Update



Adam Rensing*, Paul Austin
Division of Urologic Surgery, Washington University in St. Louis School of Medicine, St Louis, MO, USA


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© Rensing and Austin; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO. 63110, USA; Tel: 314-454-6034; E-mail: rensinga@wudosis.wustl.edu


Abstract

Vesicoureteral reflux [VUR] remains a common problem seen by pediatric providers. Despite a great deal of research, the debate regarding how to screen and treat patients reremains tense and controversial. This review seeks to summarize the management of VUR with emphasis on recent published findings in the literature and how they contribute to this debate. The goals of managing VUR include preventing future febrile urinary tract infections [FUTI], renal scarring, reflux nephropathy and hypertension. The topdown approach with upper tract imaging and selective vesicocystourethrogram [VCUG] is an emerging alternative approach in the evaluation of children after their first FUTI. The elimination of bladder and bowel dysfunction [BBD] is an important management strategy to prevent further FUTIs, regardless of treatment choice. Antibiotic prophylaxis is a safe and effective modality to sterilize the urinary tract. Endoscopic treatment of VUR is an attractive modality in select patients, although some concerns remain regarding its effectiveness and durability as compared to to the gold standard of open or laparoscopic ureteroneocystostomy. Lastly, further research is required to determine the most effective algorithm to evaluate the pediatric patient after the first febrile UTI.

Keywords: Antibiotic prophylaxis, bladder and bowel dysfunction, dysfunctional voiding, lower urinary tract dysfunction, pyelonephritis renal scarring, urinary tract infection, ureteral reimplantation, vesicoureteral reflux.