Management

Medical Management

• continuous antibiotic prophylaxis (CAP) helps to prevent UTI and associated renal scarring
  • VUR with febrile UTI is associated with high morbidity in infants (1)
    • use CAP for them regardless of VUR grade. CAP is recommended for high-grade VUR (III-V) regardless of UTI
    • note that most, VUR will resolve spontaneously; 20% to 30% will have further infections, but few will experience long-term renal sequelae (2)

Surgical Management

• surgery ( i.e. correction of the underlying abnormality - by tunnelling the ureter through the bladder wall) is the treatment of choice in recurrent UTI despite CAP, high-grade reflux, low probability of spontaneous resolution, and evidence of renal damage (1)

Follow up depends on the renal function, and the degree of scarring of the kidneys. The presence of the latter requires long term follow up to monitor for hypertension.

Note - spontaneous resolution of VUR frequently occurs before age 5, especially in younger patients, males, and those with lower VUR grades (I-III), making surgical intervention unnecessary in uncomplicated cases. (3)

Reference:

1. Banker H, Aeddula NR. Vesicoureteral Reflux. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022.
2. Williams G, Fletcher JT, Alexander SI, Craig JC. Vesicoureteral reflux. J Am Soc Nephrol. 2008 May;19(5):847-62.
3. Wildbrett P, Schwebs M, Abel JR, Lode H, Barthlen W. Spontaneous vesicoureteral reflux resolution in children: A ten-year single-centre experience. Afr J Paediatr Surg. 2013 Jan-Apr;10(1):9-12