Treating VUR

There are three goals in the treatment of VUR1

According to the American Urologic Association (AUA), the primary goals of VUR management are:1

  • Prevent febrile urinary tract infections (fUTIs)
  • Prevent renal injury
  • Minimize follow-up and morbidity

Patients and families, in consultation with a pediatric urologist, can best determine which management or treatment option provides opportunity to accomplish these three goals.

A variety of treatment options are available for VUR:

Surveillance
Description Monitor for symptoms of UTI
Use Patients with the lowest risk of recurrent UTI
Antibiotic Prophylaxis
Description Low, daily dose of antibiotic prophylaxis
Use To provide some reduction in the risk of children at risk of recurrent fUTI2
Endoscopic Treatment With Deflux
Description Minimally invasive endoscopic subureteric injection of bulking agent
Use For curative VUR treatment and reduction in risk for recurrent fUTI in children with grades II-IV reflux3
Open Surgery (Ureteral Reimplantation)
Description Surgical reimplantation of ureter(s) at bladder insertion
Use For curative VUR treatment and reduction in risk for recurrent fUTI4
References:
  1. American Urological Association. Management and screening of primary vesicoureteral reflux in children: AUA guideline. 2010.
  2. RIVUR Trial Investigators, Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, Pohl HG, Kropp BP, Skoog SJ, Nelson CP, Moxey-Mims M, Chesney RW, Carpenter MA. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014 Jun 19;370(25):2367-76. DOI: 10.1056/NEJMoa1401811
  3. 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 vesicoureteral reflux. J Pediatr Urol. 2012;9(4)359-365. DOI: https://DOI.org/10.1016/j.jpurol.2011.07.006
  4. Nelson CP, Hubert KC, Kokorowski PJ et al. Long-term incidence of urinary tract infection after ureteral reimplantation for primary vesicoureteral reflux. J Pediatr Urol. 2013:9;92-98. DOI: 10.1016/j.jpurol.2011.12.009
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