Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 10/2014

01-10-2014 | Pediatric Urology (M Castellan and R Gosalbez, Section Editors)

Vesicoureteral Reflux: Current Management in Children

Authors: Pedro-Jose Lopez, Soledad Celis, Francisco Reed, Ricardo Zubieta

Published in: Current Urology Reports | Issue 10/2014

Login to get access

Abstract

Vesicoureteral reflux (VUR) is a disorder that has been studied since the early days of pediatric urology. From 1893, when it was first documented in humans by Pozzi, the research and clinical management of VUR has been marked by pendulum swings through the decades. Initially, the vesicoureteral junction was the main subject of study, whereas current practice takes into account the bladder and bowel dynamics. The primary objective, however, is unchanged: preservation of the kidney and its function. Management of the condition has included open surgery, minimally invasive surgery, endoscopic treatment, antibiotic prophylaxis, and watchful waiting. In this article, we will attempt to cover every angle of this complex pathology and its current management in children.
Literature
1.
Sargent MA. What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol. 2000;30:587–93.PubMedCrossRef
2.•
Skoog SJ, Peters CA, Arant Jr BS, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol. 2010;184:1145–51. They are guidelines which as review the literature extensibly providing a good summary of key issues about VUR.PubMedCrossRef
3.
Estrada Jr CR, Passerotti CC, Graham DA, et al. Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2,462 children. J Urol. 2009;182:1535–41.PubMedCrossRef
4.•
Peters CA, Skoog S, Arant B, et al. Summary of the AUA Guideline on management of primary vesicoureteral reflux in children. J Urol. 2010;184:1134–44. They are guidelines which as review the literature extensibly providing a good summary of key issues about VUR PubMedCrossRef
5.
Routh JC, Grant FD, Kokorowski PJ, et al. Economic and radiation costs of initial imaging approaches after a child’s first febrile urinary tract infection. Clin Pediatr (Phila). 2012;51(1):23–30.CrossRef
6.
Tekgül S, Riedmiller H, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, et al. EAU Guidelines on vesicoureteral reflux in children. Eur Urol. 2012;62:534–42.PubMedCrossRef
7.•
Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128:595–610. They are guidelines which as review the literature extensibly providing a good summary of key issues about VUR PubMedCrossRef
8.
9.
Unver T, Alpay H, Biyikli NK, Ones T. Comparison of direct radionuclide cystography and voiding cystourethrography in detecting vesicoureteral reflux. Pediatr Int. 2006;48(3):287–91.PubMedCrossRef
10.
Darge K. Voiding urosonography with US contrast agent for the diagnosis of vesicoureteric reflux in children: an update. Pediatr Radiol. 2010;40:956–62.PubMedCrossRef
11.
Westwood ME, Whiting PF, Cooper J, et al. Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr. 2005;5:2.PubMedCrossRefPubMedCentral
12.
Zhang X, Xu H, Zhou L, et al. Accuracy of early DMSA scan for VUR in young children with febrile UTI. Pediatrics. 2014;133:e30.PubMedCrossRef
13.
Stefanidis CJ, Siomou E. Imaging strategies for vesicoureteral reflux diagnosis. Pediatr Nephrol. 2007;22:937–47.PubMedCrossRef
14.
15.
16.
Elder JS, Peters CA, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol. 1997;157:1846–51.PubMedCrossRef
17.
Sjöström S, Sillén U, Bachelard M, Hansson S, Stokland E. Spontaneous resolution of high grade infantile vesicoureteral reflux. J Urol. 2004;172:694–8.PubMedCrossRef
18.
Sjöström S, Sillén U, Jodal U, et al. Predictive factors for resolution of congenital high grade vesicoureteral reflux in infants: results of univariate and multivariate analyses. J Urol. 2010;183:1177–84.PubMedCrossRef
19.
Montini G, Rigon L, Zucchetta P, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. 2008;122:1064.PubMedCrossRef
20.
Pennesi M, Travan L, Peratoner L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 2008;121:e1489.PubMedCrossRef
21.
Roussey-Kesler G, Gadjos V, Idres N, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol. 2008;179:674.PubMedCrossRef
22.
Brandström P, Esbjörner E, et al. The Swedish Reflux Trial in Children, III: urinary tract infection pattern. J Urol. 2010;184:286–91.PubMedCrossRef
23.
Kibar Y, Ors O, Demir E, et al. Results of biofeedback treatment on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux. Urology. 2007;70(3):563–6.PubMedCrossRef
24.
Sillén U. Bladder dysfunction and vesicoureteral reflux. Adv Urol. 2008;815472.
25.
Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral al reflux and urinary tract infections in children. J Urol. 1998;160:1019–22.PubMedCrossRef
26.
Snodgrass W. The impact of treated dysfunctional voiding on the nonsurgical management of vesicoureteral reflux. J Urol. 1998;160(5):1823–5.PubMedCrossRef
27.
Ladenhauf HN, Ardelean MA, Schimke C, Yankovic F, Schimpl G. Reduced bacterial colonisation of the glans penis after male circumcision in children: prospective study. J Pediatr Urol. 2013;9:1137–44.PubMedCrossRef
28.
Gücük A, Burgu B, Gökçe İ, Mermerkaya M, Soygür T. Do antibiotic prophylaxis and/or circumcision change periurethral uropathogen colonization and urinary tract infection rates in boys with VUR? J Pediatr Urol. 2013;9:1131–6.PubMedCrossRef
29.
Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child. 2005;90:853–8.PubMedCrossRefPubMedCentral
30.•
Morris B, Wiswell T. Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis. J Urol. 2013;189:2118–24. Explain the circumcision and VUR, debate that seems never ends.PubMedCrossRef
31.••
Peters CA, Skoog S, Arant B, et al. Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol. 2010;184(3):1134–44. doi:10.​1016/​j.​juro.​2010.​05.​065. They are guidelines which as review the literature extensibly providing a good summary of key issues about VUR PubMedCrossRef
32.
33.
34.
O’Donnell B, Puri P. Treatment of vesicoureteric reflux by endoscopic injection of Teflon. Br Med J (Clin Res Ed). 1984;289:7–9.CrossRef
35.
Kirsch AJ, Perez-Brayfield M, Smith EA, Scherz HC. The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol. 2004;171:2413–6.PubMedCrossRef
36.
Kalisvaart JF, Scherz HC, Cuda S, Kaye JD, Kirsch AJ. Intermediate to long-term follow-up indicates low risk of recurrence after double HIT endoscopic treatment for primary vesico-ureteral reflux. J Pediatr Urol. 2012;8:359–65.PubMedCrossRef
37.
38.•
Elder JS, Diaz M, Caldamone AA, et al. Endoscopic therapy for vesicoureteral reflux: a meta-analysis, I: reflux resolution and urinary tract infection. J Urol. 2006;175:716–22. A good metaanalysis regarding endoscopic treatment and how it seems that the pendulum is moving back.PubMedCrossRef
39.
Chertin B, Kocherov S. Long-term results of endoscopic treatment of vesicoureteric reflux with different tissue-augmenting substances. J Pediatr Urol. 2010;6:251–6.PubMedCrossRef
40.
41.
Läckgren G, Wåhlin N, Sköldenberg E, et al. Long-term followup children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol. 2001;166:1887–92.PubMedCrossRef
42.
Vandersteen DR, Routh JC, Kirsch AJ, et al. Postoperative ureteral obstruction after subureteral injection of dextranomer/hyaluronic acid copolymer. J Urol. 2006;176:1593–5.PubMedCrossRef
43.
Mazzone L, Gobet R, González R, Zweifel N, Weber DM. Ureteral obstruction following injection of dextranomer/hyaluronic acid copolymer: an infrequent but relevant complication. J Pediatr Urol. 2012;8:514–9.PubMedCrossRef
44.
García-Aparicio L, Rodo J, Palazon P, et al. Acute and delayed vesicoureteral obstruction after endoscopic treatment of primary vesicoureteral reflux with dextranomer/hyaluronic acid copolymer: why and how to manage. J Pediatr Urol. 2013;9:493–7.PubMedCrossRef
45.
Alizadeh F, Mazdak H, Khorrami MH, Khalighinejad P, Shoureshi P. Postoperative ureteral obstruction after endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer (Vantris®). J Pediatr Urol. 2013;9:488–92.PubMedCrossRef
46.
Rubenwolf PC, Ebert AK, Ruemmele P, Rösch W. Delayed-onset ureteral obstruction after endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for treatment of vesicoureteral reflux in children: a case series. Urology. 2013;81(3):659–62.PubMedCrossRef
47.
Capozza N, Lais A, Matarazzo E, et al. Treatment of vesico-ureteric reflux: a new algorithm based on parental preference. BJU Int. 2003;92:285–8.PubMedCrossRef
48.
49.
Austin JC, Cooper CS. Vesicoureteral reflux: surgical approaches. Urol Clin N Am. 2004;31:543–57.CrossRef
50.
51.
Zubieta R, López PJ. Surgical technique for extravesical vesicoureteral neoimplantation. Arch Esp Urol. 2008;61(8):873–81.PubMedCrossRef
52.
Palmer J. Bilateral extravesical ureteral reimplantation in toilet-trained children: short-stay procedure without urinary retention. Urology. 2009;73:285–8.PubMedCrossRef
53.
Castellán M, García Mérida M, Gosálbez R. Transitory urinary retention after simultaneous bilateral extravesical ureteral reimplantation. Arch Esp Urol. 2008;61(2):316–9.PubMedCrossRef
54.
Ehrlich RM, Gershman A, Fuchs G. Laparoscopic vesicoureteroplasty in children: initial case reports. Urol. 1994;433:255–61.CrossRef
55.
56.
Caillaud C, Lacreuse I, Fothergill H, Becmeur F, Fischbach M. Observational, medical or surgical management of vesicoureteric reflux. Acta Pediatrica. 2013;102:222–5.CrossRef
Metadata
Title
Vesicoureteral Reflux: Current Management in Children
Authors
Pedro-Jose Lopez
Soledad Celis
Francisco Reed
Ricardo Zubieta
Publication date
01-10-2014
Publisher
Springer US
Published in
Current Urology Reports / Issue 10/2014
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-014-0447-9

Other articles of this Issue 10/2014

Current Urology Reports 10/2014 Go to the issue

Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)

Lower Urinary Tract Symptoms in Women with Diabetes Mellitus: A Current Review

Office Urology (N Shore, Section Editor)

Optimizing Urology Group Partnerships: Collaboration Strategies and Compensation Best Practices

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Robotic-Assisted Simple Prostatectomy: Is there Evidence to go Beyond the Experimental Stage?

Men's Health (R Carrion and C Yang, Section Editors)

Surgical Management of Peyronie’s Disease

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Impact of Alpha Blockers, 5-alpha Reductase Inhibitors and Combination Therapy on Sexual Function

Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)

The Evaluation and Management of Refractory Neurogenic Overactive Bladder