Vesicoureteral Reflux Guidelines

Updated: Dec 14, 2018
  • Author: Carlos Roberto Estrada, Jr, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Guidelines Summary

In 2017, the American Urological Association confirmed the validity of its 2010 guidelines for the management of vesicoureteral reflux (VUR) in children, which serve as a good resource for patients, parents, and physicians. [9]   Recommendations for antibiotic prophylaxis vary according to age at diagnosis.

For initial management of VUR in children < 1 year, recommendations are as follows [9] :

  • Continuous antibiotic prophylaxis (CAP), if child has a history of a febrile urinary tract infection (UTI)
  • Offer CAP for VUR grades III–V, if child has no history of febrile UTI 
  • Consider CAP for VUR grades I-II, if child has no history of febrile UTI

For initial management of VUR in children > 1 year, recommendations are as follows [9] ​:

  • CAP for the child with bladder/bowel dysfunction and VUR due to the increased risk of UTI while bladder/bowel dysfunction (BBD) is present and being treated 
  • CAP may be considered for the child with a history of UTIs in the absence of BBD
  • Observational management without CAP, with prompt initiation of antibiotic therapy for UTIs, may be considered for the child with VUR in the absence of bladder/bowel dysfunction, recurrent febrile UTIs, or renal cortical abnormalities 
  • Surgical intervention for VUR, including both open and endoscopic methods, may be used. 

If symptomatic breakthrough UTI occurs (manifest by fever, dysuria, frequency, failure to thrive, or poor feeding), a change in therapy is recommended. If symptomatic breakthrough urinary tract infection occurs, the clinical scenario will guide the choice of treatment alternatives; this includes VUR grade, degree of renal scarring, if any, and evidence of abnormal voiding patterns (bladder/bowel dysfunction) that might contribute to UTI, as well as parental preferences.

Patients receiving CAP with a febrile breakthrough UTI should be considered for open surgical ureteral reimplantation or endoscopic injection of bulking agents for intervention with curative intent. However, if there is no evidence of pre-existing or new renal cortical abnormalities, changing to an alternative antibiotic agent is an option prior to surgical intervention with curative intent.

Patients not receiving CAP who develop a febrile UTI should begin CAP.