Skip to main content
SpringerLink
Log in

Vesicoureteral Reflux

  • Chapter
  • First Online:
Pediatric Urology

  • 2009 Accesses

Abstract

Primary aims in the diagnosis and management of vesicoureteral reflux (VUR):

  1. 1.

    Reduce recurrent febrile urinary tract infection (fUTI).

  2. 2.

    Prevent acquired renal damage.

Summary of evidence for these aims:

Children with VUR have been assumed to have high risk for renal scarring and recurrent fUTI, justifying therapy in most patients. However:

  • RCTs indicate only approximately one-third of patients with VUR will have recurrent UTI within 2 years of diagnosis

  • Acquired renal scarring occurs in approximately 15 % of children with VUR after fUTI.

  • If DMSA scan for renal scar is negative, risk subsequent fUTI will cause renal damage is ≤10 %.

  • No randomized controlled trial (RCT) has been done to determine if VUR therapy (medical or surgical) decreases additional acquired renal damage in children with renal scar at presentation.

  • Antibiotic prophylaxis is no more effective than placebo to prevent recurrent UTI in children 1–24 months of age with grades 1–4 VUR.

  • There are no data regarding benefit of antibiotic prophylaxis in children >2 years of age with VUR, with VUR and no history of UTI, with grade 5 VUR, or with recurrent UTI.

  • Surgical correction of VUR (reimplantation or endoscopic injection) reduces recurrent fUTI.

  • Identification and treatment of voiding dysfunction in children with VUR has not been clearly demonstrated to improve resolution or reduce fUTI.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • AAP 2011. Roberts KB, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. 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(3):595–610.

    Article  PubMed  Google Scholar 

  • Barrieras D, Lapointe S, Reddy PP, Williot P, McLorie GA, Bagli D, et al. Urinary retention after bilateral extravesical ureteral reimplantation: does dissection distal to the ureteral orifice have a role? J Urol. 1999;162(3 Pt 2):1197–200.

    PubMed  CAS  Google Scholar 

  • Barroso Jr U, Barroso VA, de Bessa J, Jr CAA, Zerati FM. Predictive factors for contralateral reflux in patients with conservatively treated unilateral vesicoureteral reflux. J Urol. 2008;180(1):297–9. discussion 9.

    Article  PubMed  Google Scholar 

  • Bisignani G, Decter RM. Voiding cystourethrography after uncomplicated ureteral reimplantation in children: is it necessary? J Urol. 1997;158(3 Pt 2):1229–31.

    PubMed  CAS  Google Scholar 

  • Brandstrom P, Esbjorner E, Herthelius M, Swerkersson S, Jodal U, Hansson S. The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol. 2010;184(1):286–91.

    Article  PubMed  Google Scholar 

  • Burno DK, Glazier DB, Zaontz MR. Lessons learned about contralateral reflux after unilateral extravesical ureteral advancement in children. J Urol. 1998;160(3 Pt 2):995–7. discussion 1038.

    PubMed  CAS  Google Scholar 

  • Casale P, Patel RP, Kolon TF. Nerve sparing robotic extravesical ureteral reimplantation. J Urol. 2008;179(5):1987–9. discussion 90.

    Article  PubMed  Google Scholar 

  • Chi A, Gupta A, Snodgrass W. Urinary tract infection following successful dextranomer/hyaluronic acid injection for vesicoureteral reflux. J Urol. 2008;179(5):1966–9.

    Article  PubMed  Google Scholar 

  • Choi H, Oh SJ, So Y, Lee DS, Lee A, Kim KM. No further development of renal scarring after antireflux surgery in children with primary vesicoureteral reflux: review of the results of 99mtechnetium dimercapto-succinic acid renal scan. J Urol. 1999;162(3 Pt 2):1189–92.

    PubMed  CAS  Google Scholar 

  • Craig JC, Irwig LM, Knight JF, Sureshkumar P, Roy LP. Symptomatic urinary tract infection in preschool Australian children. J Paediatr Child Health. 1998;34(2):154–9.

    Article  PubMed  CAS  Google Scholar 

  • Duckett JW, Walker RD, Weiss R. Surgical results: International Reflux Study in Children–United States branch. J Urol. 1992;148(5 Pt 2):1674–5.

    PubMed  CAS  Google Scholar 

  • Elder JS, Peters CA, Arant Jr BS, Ewalt DH, Hawtrey CE, Hurwitz RS, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol. 1997;157(5):1846–51.

    Article  PubMed  CAS  Google Scholar 

  • Elder JS, Diaz M, Caldamone AA, Cendron M, Greenfield S, Hurwitz R, et al. Endoscopic therapy for vesicoureteral reflux: a meta-analysis. I Reflux resolution and urinary tract infection J Urol. 2006;175(2):716–22.

    Google Scholar 

  • Elmore JM, Kirsch AJ, Lyles RH, Perez-Brayfield MR, Scherz HC. New contralateral vesicoureteral reflux following dextranomer/hyaluronic Acid implantation: incidence and identification of a high risk group. J Urol. 2006;175(3 Pt 1):1097–100. discussion 100–1.

    Article  PubMed  Google Scholar 

  • Estrada Jr CR, Passerotti CC, Graham DA, Peters CA, Bauer SB, Diamond DA, et al. Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2,462 children. J Urol. 2009;182(4):1535–41.

    Article  PubMed  Google Scholar 

  • Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006;117(3):626–32.

    Article  PubMed  Google Scholar 

  • Gupta A, Snodgrass W. Intra-orifice versus hydrodistention implantation technique in dextranomer/hyaluronic acid injection for vesicoureteral reflux. J Urol. 2008;180(4 Suppl):1589–92. discussion 92–3.

    Article  PubMed  Google Scholar 

  • Higham-Kessler J, Reinert SE, Snodgrass WT, Hensle TW, Koyle MA, Hurwitz RS, et al. A review of failures of endoscopic treatment of vesicoureteral reflux with dextranomer microspheres. J Urol. 2007;177(2):710–4. discussion 4–5.

    Article  PubMed  Google Scholar 

  • Hjalmas K, Lohr G, Tamminen-Mobius T, Seppanen J, Olbing H, Wikstrom S. Surgical results in the International Reflux Study in Children (Europe). J Urol. 1992;148(5 Pt 2):1657–61.

    PubMed  CAS  Google Scholar 

  • Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 2003;348(3):195–202.

    Article  PubMed  Google Scholar 

  • Hoenig DM, Diamond DA, Rabinowitz R, Caldamone AA. Contralateral reflux after unilateral ureteral reimplantation. J Urol. 1996;156(1):196–7.

    Article  PubMed  CAS  Google Scholar 

  • Hollowell JG. Outcome of pregnancy in women with a history of vesico-ureteric reflux. BJU Int. 2008;102(7):780–4.

    Article  PubMed  Google Scholar 

  • Ismaili K, Lolin K, Damry N, Alexander M, Lepage P, Hall M. Febrile urinary tract infections in 0- to 3-month-old infants: a prospective follow-up study. J Pediatr. 2011;158(1):91–4.

    Article  PubMed  Google Scholar 

  • Kibar Y, Ors O, Demir E, Kalman S, Sakallioglu O, Dayanc M. Results of biofeedback treatment on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux. Urology. 2007;70(3):563–6. discussion 6–7.

    Article  PubMed  Google Scholar 

  • Lackgren G, Wahlin N, Skoldenberg E, Stenberg A. Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol. 2001;166(5):1887–92.

    Article  PubMed  CAS  Google Scholar 

  • Lapointe SP, Barrieras D, Leblanc B, Williot P. Modified Lich-Gregoir ureteral reimplantation: experience of a Canadian center. J Urol. 1998;159(5):1662–4.

    Article  PubMed  CAS  Google Scholar 

  • Lee EK, Gatti JM, Demarco RT, Murphy JP. Long-term followup of dextranomer/hyaluronic acid injection for vesicoureteral reflux: late failure warrants continued followup. J Urol. 2009;181(4):1869–74. discussion 74–5.

    Article  PubMed  CAS  Google Scholar 

  • McAchran SE, Palmer JS. Bilateral extravesical ureteral reimplantation in toilet trained children: Is 1-day hospitalization without urinary retention possible? J Urol. 2005;174(5):1991–3. discussion 3.

    Article  PubMed  Google Scholar 

  • Menezes M, Mohanan N, Haroun J, Colhoun E, Puri P. New contralateral vesicoureteral reflux after endoscopic correction of unilateral reflux–is routine contralateral injection indicated at initial treatment? J Urol. 2007;178(4 Pt 2):1711–3.

    Article  PubMed  Google Scholar 

  • Palmer LS, Franco I, Rotario P, Reda EF, Friedman SC, Kolligian ME, et al. Biofeedback therapy expedites the resolution of reflux in older children. J Urol. 2002;168(4 Pt 2):1699–702. discussion 702–3.

    PubMed  Google Scholar 

  • Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani 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(6):e1489–94.

    Article  PubMed  Google Scholar 

  • Peters CA, Skoog SJ, Arant Jr BS, Copp HL, Elder JS, Hudson RG, et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol. 2010;184(3):1134–44.

    Article  PubMed  Google Scholar 

  • Piepsz A, Tamminen-Mobius T, Reiners C, Heikkila J, Kivisaari A, Nilsson NJ, et al. Five-year study of medical or surgical treatment in children with severe vesico-ureteral reflux dimercaptosuccinic acid findings. International Reflux Study Group in Europe Eur J Pediatr. 1998;157(9):753–8.

    CAS  Google Scholar 

  • Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, 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(2):674–9. discussion 9.

    Article  PubMed  CAS  Google Scholar 

  • Routh JC, Inman BA, Ashley RA, Vandersteen DR, Reinberg Y, Wolpert JJ, et al. Unilateral vesicoureteral reflux: does endoscopic injection based on the cystoscopic appearance of the ureteral orifice decrease the incidence of de-novo contralateral reflux? J Pediatr Urol. 2008;4(4):260–4.

    Article  PubMed  Google Scholar 

  • Routh JC, Reinberg Y, Ashley RA, Inman BA, Wolpert JJ, Vandersteen DR, et al. Multivariate comparison of the efficacy of intraureteral versus subtrigonal techniques of dextranomer/hyaluronic acid injection. J Urol. 2007;178(4 Pt 2):1702–5. discussion 5–6.

    Article  PubMed  Google Scholar 

  • Routh JC, Inman BA, Reinberg Y. Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review. Pediatrics. 2010;125(5):1010–9.

    Article  PubMed  Google Scholar 

  • Scholtmeijer RJ, Nijman RJ. Vesicoureteric reflux and videourodynamic studies: results of a prospective study after three years of follow-up. Urology. 1994;43(5):714–8.

    Article  PubMed  CAS  Google Scholar 

  • Schwentner C, Gozzi C, Lunacek A, Rehder P, Bartsch G, Oswald J, et al. Interim outcome of the single stage dorsal inlay skin graft for complex hypospadias reoperations. J Urol. 2006;175(5):1872–6. discussion 6–7.

    Article  PubMed  CAS  Google Scholar 

  • Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010;126(6):1084–91.

    Article  PubMed  Google Scholar 

  • Siomou E, Giapros V, Fotopoulos A, Aasioti M, Papadopoulou F, Serbis A, et al. Implications of 99mTc-DMSA scintigraphy performed during urinary tract infection in neonates. Pediatrics. 2009;124(3):881–7.

    Article  PubMed  Google Scholar 

  • Skoog SJ, Peters CA, Arant Jr BS, Copp HL, Elder JS, Hudson RG, 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(3):1145–51.

    Article  PubMed  Google Scholar 

  • Snodgrass W. The impact of treated dysfunctional voiding on the nonsurgical management of vesicoureteral reflux. J Urol. 1998;160(5):1823–5.

    Article  PubMed  CAS  Google Scholar 

  • Snodgrass W, Shah A, Yang M, Kwon J, Villanueva C, Traylor J, et al. Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: a cross-sectional observational study of 565 consecutive patients. J Pediatr Urol. (2012), http://dx.doi.org/10.1016/j.jpurol.2012.11.019.

  • Soylu A, Demir BK, Turkmen M, Bekem O, Saygi M, Cakmakci H, et al. Predictors of renal scar in children with urinary infection and vesicoureteral reflux. Pediatr Nephrol (Berlin, Germany). 2008;23(12):2227–32.

    Article  Google Scholar 

  • Traxel E, DeFoor W, Reddy P, Sheldon C, Minevich E. Risk factors for urinary tract infection after dextranomer/hyaluronic acid endoscopic injection. J Urol. 2009;182(4 Suppl):1708–12.

    Article  PubMed  Google Scholar 

  • Wadie GM, Tirabassi MV, Courtney RA, Moriarty KP. The deflux procedure reduces the incidence of urinary tract infections in patients with vesicoureteral reflux. J Laparoendosc Adv Surg Tech A. 2007;17(3):353–9.

    Article  PubMed  Google Scholar 

  • Webster RI, Smith G, Farnsworth RH, Rossleigh MA, Rosenberg AR, Kainer G. Low incidence of new renal scars after ureteral reimplantation for vesicoureteral reflux in children: a prospective study. J Urol. 2000;163(6):1915–8.

    Article  PubMed  CAS  Google Scholar 

  • Wheeler D, Vimalachandra D, Hodson EM, Roy LP, Smith G, Craig JC. Antibiotics and surgery for ­vesicoureteric reflux: a meta-analysis of randomised controlled trials. Arch Dis Child. 2003;88(8):688–94.

    Article  PubMed  CAS  Google Scholar 

  • Yucel S, Gupta A, Snodgrass W. Multivariate analysis of factors predicting success with dextranomer/hyaluronic acid injection for vesicoureteral reflux. J Urol. 2007;177(4):1505–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Urology, University of Texas Southwestern Medical Center and Children’s Medical Center Dallas, 1935 Medical District Drive, MS F4.04, Dallas, TX, 75235, USA

    Warren T. Snodgrass M.D. & Nicol C. Bush M.D., M.S.C.S.

Authors
  1. Warren T. Snodgrass M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicol C. Bush M.D., M.S.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Warren T. Snodgrass M.D. .

Editor information

Editors and Affiliations

  1. Children’s Medical Center Dallas, Department of Pediatric Urology, University of Texas Southwestern Medical, N/A, Dallas, 75235, Texas, USA

    Warren T. Snodgrass

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Snodgrass, W.T., Bush, N.C. (2013). Vesicoureteral Reflux. In: Snodgrass, W. (eds) Pediatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6910-0_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6910-0_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6909-4

  • Online ISBN: 978-1-4614-6910-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation