Materiały źródłowe

• #1 Vesicoureteral reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vesicoureteral-reflux/diagnosis-treatment/drc-20378824

  Diagnosis involves the steps that your healthcare professional takes to find out if your child has vesicoureteral reflux. A urine test can reveal whether your child has a UTI. Other tests may be needed, including: […] Specialized X-ray of the urinary system. This test is called a voiding cystourethrogram, or VCUG. It uses X-rays of the bladder when it’s full and when it’s emptying to spot clues to health issues. […] Try to get tested at a center that has lots of experience using catheters. If your baby or young child needs a VCUG, choose a center that knows how to minimize radiation exposure. […] After the tests, healthcare professionals grade the degree of reflux. With the mildest reflux, urine backs up only to the ureter. This is called grade 1. The most serious reflux involves kidney swelling, called hydronephrosis, and twisting of the ureter. This is known as grade 5.

• #2 Vesicoureteral Reflux Diagnosis & Treatment | UPMC

  https://www.upmc.com/services/urology/conditions/vesicoureteral-reflux

  Reflux is diagnosed using an x-ray called a voiding cystourethrogram (VCUG), or a nuclear cystogram. […] Both tests involve a urinary catheter (tube) placed into the child’s bladder to fill the bladder with x-ray dye or radioactive material. The dye is then observed during urination and, if it is seen going up toward the kidneys, the diagnosis is made. […] Your doctor will be concerned about diagnosis of reflux because reflux can lead to kidney damage. Refluxing urine can carry bacteria to the kidney, where it can establish a kidney infection. […] Children with reflux of urine are more likely to have kidney infections than children who do not have reflux. The combination of reflux and infection can lead to areas of permanent kidney damage or „renal scarring.” […] This scarring was detected in the past by doing an x-ray called an intravenous pyelogram (IVP), but now more commonly evaluated with a renal scan.

• #3 Vesicoureteral reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vesicoureteral-reflux/diagnosis-treatment/drc-20378824

  Healthcare professionals usually spot vesicoureteral reflux as part of follow-up testing when an infant or young child has a urinary tract infection. […] For vesicoureteral reflux, some basic questions to ask your child’s healthcare professional include: What kinds of tests does my child need? […] The best treatment option for vesicoureteral reflux often isn’t clear-cut. To choose a treatment that seems right to you and your child, it’s important that you understand your child’s condition.

• #4 Vesicoureteral Reflux (VUR) | Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/v/vesicoureteral-reflux

  What Is VUR? Vesicoureteral reflux (VUR) is a condition in which urine from the bladder is able to flow back up into the ureter and kidney. It is caused by a problem with the valve mechanism. Pressure from the urine filling the bladder should close the tunnel of the ureter. It should not allow urine to flow back up into the ureter. When the ureter enters the bladder at an unusual angle reflux can can occur. This can also happen when the length of the ureter that tunnels through the bladder wall is too short. […] VUR is most often found during an evaluation for a urinary tract infection (UTI) by your child’s primary care provider. After a UTI, a few tests can be ordered. […] A voiding cystourethrogram (sis-toe-yu-ree-thro-gram) (VCUG) is an X-ray test. A small tube or catheter is placed into the bladder through the opening where the urine comes out. A special liquid, called X-ray contrast, is used to fill the bladder through the catheter. When the bladder is full, the child will urinate into a special holder while on the X-ray table. While the bladder is filling and the child is urinating, X-rays are taken.

• #5 VUR tests and diagnosis | infoKID

  https://infokid.org.uk/conditions/vesicoureteral-reflux-vur-and-reflux-nephropathy/vur-tests-and-diagnosis/

  VUR tests and diagnosis VUR tests and diagnosis […] Some babies with antenatal hydronephrosis are tested for VUR and other kidney conditions after birth. […] In older children, VUR is normally found when looking for other problems, such as a urinary tract infection (UTI). […] Your child may have an MCUG (sometimes called a VCUG). […] Another test that may be used instead for older children (who are potty trained) is an MAG3 scan with indirect cystogram. […] Your child may need other scans to check for any scarring on the kidneys (reflux nephropathy). […] A urine test can diagnose a urinary tract infection (UTI) or find protein in the urine (proteinuria). […] Your child may need a blood test. A blood test can find out about your child’s kidney function (how well his or her kidneys are working) by measuring the glomerular filtration rate (GFR).

• #6 The Diagnosis and Medical Management of Vesicoureteral Reflux: An Update and Current Controversies | SpringerLink

  https://link.springer.com/10.1007/978-3-642-38482-0_178-1

  Primary vesicoureteral reflux (VUR) is most often diagnosed in children after a urinary tract infection (UTI), in infants with a prenatal ultrasound showing hydronephrosis, or in asymptomatic siblings of probands with VUR. […] While other diagnostic modalities have been advocated, the voiding cystourethrogram (VCUG) remains the most accurate. […] Renal scarring, either due to renal dysplasia at birth or after pyelonephritis, is the most consequential of the sequelae of undiagnosed and untreated VUR. […] Continuous prophylaxis has been shown to prevent recurrent UTIs during the years of observation. […] Most recently, the results of the NIH-sponsored RIVUR (Randomized Intervention for children with Vesicoureteral Reflux) Trial were published, showing that continuous prophylaxis halved the number of UTIs over a 2-year observation period. […] The presence of bowel and bladder dysfunction (BBD) was a significant contributing factor to recurrent UTI. […] The identification of those at greatest risk who would benefit from treatment remains a challenge for future research.

• #7 Vesicoureteral Reflux (VUR) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/vesicoureteral-reflux-vur

  Vesicoureteral reflux (VUR) occurs when urine in the bladder flows back into one or both ureters and often back into the kidneys. […] VUR is graded according to severity from grade 1 (mild) to grade 5 (severe). […] Voiding cystourethrogram (VCUG) is used to confirm the diagnosis of VUR. […] The VCUG takes 15 to 20 minutes. […] About 30 percent of children who have a UTI with a fever will be diagnosed with VUR. […] If the degree of dilation is significant enough, we may recommend a VCUG to check for reflux. […] Each year, we evaluate and treat nearly 800 children with VUR. […] The goal is to prevent UTIs and kidney damage while the reflux is improving. […] Children who have grade 4 and 5 reflux or who have had repeated UTIs with concerns of kidney scarring, may require surgical intervention to fix the reflux.

• #8 How is VUR diagnosed and graded? – Deflux

  https://deflux.com/hcp/vesicoureteral-reflux/diagnosing-grading-vur/

  How is VUR diagnosed and graded? […] A VUR Diagnosis usually comes after a febrile UTI is confirmed […] VUR is most often detected as a result of diagnostic investigations of fUTI or of hydronephrotic (distended) kidney. It may also be suspected in children presenting with high blood pressure or kidney insufficiency. […] Accurate diagnosis and grading of VUR can help with the implementation of individualized treatment plans. Diagnosis requires a voiding cystourethrogram (VCUG), typically performed by a radiologist equipped for the fluoroscopy and catheterization of children. […] As a result of VCUG assessment, any VUR will be graded from I to V based on the dilation of the ureter and presence and degree of distortion of renal structures. […] In the updated guidelines, VCUG is only indicated if renal and bladder ultrasonography (RBUS) reveals hydronephrosis, scarring or other findings suggesting either high-grade VUR or obstructive uropathy.

• #9 Vesicoureteral Reflux Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/439403-workup

  Different imaging strategies have been proposed for children presenting with febrile urinary tract infection (UTI) to identify significant vesicoureteral reflux (VUR) while minimizing patient morbidity, radiation exposure, and financial burden. None of these imaging strategies is universally accepted. […] Because VUR and UTI may affect renal structure and function, performing renal ultrasound to assess the upper urinary tract is recommended by the American Urological Association (AUA), with optional dimercaptosuccinic acid (DMSA) renal scanning to assess the status of the kidneys for scarring and function. […] The American Academy of Pediatrics (AAP) recommends that all febrile infants with UTIs undergo renal and bladder ultrasonography (RBUS). Voiding cystourethrography (VCUG) should not be performed routinely after the first febrile UTI; VCUG is indicated if RBUS reveals hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy, as well as in other atypical or complex clinical circumstances.

• #10 Vesicoureteral Reflux (VUR): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5995-vesicoureteral-reflux

  Vesicoureteral reflux (VUR) is when pee flows up from your bladder back into your kidney. It can cause kidney infection. […] In VUR, pee flows back or refluxes from your bladder into one or both of your ureters and, in some cases, to one or both kidneys. It happens most often due to an issue that prevents the one-way valve from functioning as it should. […] Treatment for VUR depends on the severity of your child’s symptoms, age and other factors. Mild cases may not need treatment and some children outgrow VUR. But some children need surgery or medication to treat VUR so it doesn’t cause kidney damage. […] The stages of VUR are grades and there are five of them. Five is the most severe form of VUR and one is the mildest form. […] They may order the following tests to diagnose vesicoureteral reflux (VUR): Voiding cystourethrogram (VCUG), Ultrasound, Dimercaptosuccinic acid (DMSA) scan, Radionuclide cystogram (RNC).

• #11 Vesicoureteral Reflux (VUR) – NIDDK

  https://www.niddk.nih.gov/health-information/urologic-diseases/hydronephrosis-newborns/vesicoureteral-reflux

  How do doctors diagnose vesicoureteral reflux? […] To diagnose the grade of VUR, doctors use imaging tests. […] Doctors use the following imaging tests, or tests to see organs inside the body, to help diagnose VUR. […] Health care professionals often test a urine sample, which is called urinalysis, to screen for a UTI. White blood cells and bacteria in the urine can be signs of a UTI. A urine culture is needed to confirm a UTI. […] Doctors treat VUR based on the child’s age, symptoms, and type and grade of VUR. […] Primary VUR will often get better and will go away as a child gets older. […] Doctors can sometimes diagnose a urine blockage in a fetus in the womb. Learn more about urine blockage in newborns.

• #12 8 Vesicoureteral Reflux (VUR) Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/vesicoureteral-reflux-vur-nursing-care-plans/

  Detection and management of reflux grade is necessary for appropriate management. Identifying the grade of reflux through diagnostic tests and imaging is necessary for appropriate management. […] Monitoring laboratory values, including complete blood count (CBC) and renal function tests, is essential for early detection, timely intervention, and appropriate management. Regular monitoring of laboratory values, such as CBC to detect elevated white blood cell count and renal function tests (e.g., blood urea nitrogen, creatinine) to assess kidney function, helps identify any signs of infection, kidney damage, or impaired renal function. […] Voiding cystourethrogram (VCUG) is a radiographic procedure that evaluates the anatomy and function of the urinary tract. It involves the insertion of a catheter into the bladder and the injection of a contrast agent. X-ray images are then taken during urination to assess the flow of urine and the presence of VUR. VCUG is considered the gold standard diagnostic test for VUR.

• #13 Vesicoureteral Reflux (VUR) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/vesicoureteral-reflux-vur

  Vesicoureteral reflux (VUR) can only be diagnosed by a test called a cystogram, in which a catheter is placed through the urethra into the bladder, and the bladder is filled with fluid. This procedure allows doctors to see the reverse flow of urine toward the kidney. There are two types of cystograms: […] A cystogram is most commonly done in a child who has had a UTI but may also be performed in infants who have hydronephrosis a condition detected by ultrasound before birth. […] If a child is suspected of having a urinary tract infection, the urine needs to be sampled using special techniques to avoid contamination and false test results. For younger children and infants, this usually means passing a catheter into the bladder to obtain a urine sample. In some cases, a bag will be placed on the child to collect urine, although this method has a high rate of false results. In older, toilet-trained children, the child can urinate into a cup.

• #14 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  Vesicoureteral reflux (VUR) is characterized by the abnormal backward flow of urine from the urinary bladder into the upper urinary tract during voiding. […] Voiding cystourethrogram is the preferred diagnostic tool for diagnosing VUR in children, necessitating collaboration among urologists, surgeons, and radiologists. […] The initial evaluation starts with a urinalysis (dipstick and microscopic), including an evaluation for proteinuria and bacteriuria and a urine culture and sensitivity, if indicated. […] Unfortunately, ultrasound lacks high sensitivity or specificity for detecting high-grade VUR. […] The gold standard for evaluating VUR is direct cystography with voiding cystourethrogram (VCUG). […] The initial imaging method for a child experiencing their first febrile UTI typically involves renal ultrasound, with VCUG being recommended if sonography reveals abnormalities, a second UTI occurs, or if the patient presents with other high-risk factors such as bowel or bladder dysfunction.

• #15 Vesicoureteric reflux | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/vesicoureteric-reflux?lang=us

  Vesicoureteric reflux (VUR) is the term for the abnormal flow of urine from the bladder into the upper urinary tract and is typically encountered in young children. […] The primary diagnostic procedure for evaluating vesicoureteric reflux is a voiding cystourethrogram (VCUG), which requires bladder catheterization and distention of the bladder. […] Voiding cystourethrogram (also known as micturating cystourethrogram) should be performed after the first well-documented urinary tract infection up to the age of 6 years. […] Routine ultrasound is usually also performed (in addition to voiding cystourethrogram) to assess the renal parenchyma for evidence of scarring or anatomic anomalies. […] Reflux can also be graded, although less precisely, with nuclear cystography. […] MR voiding cystourethrogram protocols are still being developed but have the advantage of not having ionizing radiation and of simultaneously imaging the renal parenchyma.

• #16 The Diagnosis and Treatment of Vesicoureteral Reflux: An Update

  https://openurologyandnephrologyjournal.com/VOLUME/8/PAGE/96/

  Vesicoureteral reflux [VUR] remains a common problem seen by pediatric providers. […] The topdown approach with upper tract imaging and selective vesicocystourethrogram [VCUG] is an emerging alternative approach in the evaluation of children after their first FUTI. […] In the United States, both the American Urological Association [AUA] and the American Academy of Pediatrics [AAP] have provided guidelines in the hope of helping pediatricians and pediatric urologists provide appropriate screening and treatment for patients with both UTIs and VUR. […] Traditionally, an acute episode of pyelonephritis prompted a diagnostic work-up that included a VCUG, and this remains the gold standard imaging test for the diagnosis of VUR. […] Once the diagnosis of VUR is established on VCUG, VUR is categorized or graded in severity by the degree of ureteral dilation on VCUG.

• #17 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  However, neither ultrasound nor radionuclide scanning can replace the VCUG as the definitive imaging modality for VUR. […] Multiple VCUG imaging cycles (at least 2) are recommended to identify reflux that may only occur early or late in the voiding cycle. […] The VCUG findings, along with the patient’s age and clinical presentation, determine the VUR grading used to formulate the treatment plan. […] An International Grading System for VUR has been established to streamline clinical decision-making processes. […] Grading VUR becomes challenging when there is a concurrent urinary tract obstruction, as ureteral dilatation and tortuosity may not solely result from VUR. […] Alternative diagnostic methods include radionuclide cystograms and contrast-enhanced voiding ultrasonography, which can be performed with simultaneous video urodynamics.

• #18 Vesicoureteral Reflux | Department of Urology

  https://www.med.unc.edu/urology/pediatrics/pediatric-conditions/vesicoureteral-reflux/

  The diagnosis of Vesicoureteral reflux is made with an x-ray study called a Voiding Cystourethrogram (VCUG). Cysto = bladder and urethrogram = x-ray of the urethra. […] If reflux is present, the VCUG will tell us the severity of the reflux on each side and will outline the anatomy of the urinary tract. A VCUG will also outline the bladder and will give much information about the shape, smoothness, and capacity of the bladder. […] The second diagnostic test in the evaluation for Reflux is the Renal Ultrasound. This non-invasive study is used to evaluate the size and shape of the kidneys as well as the bladder and may reveal areas of scaring on the kidney. […] Occasionally the urologist will ask that a renal scan (DMSA) be performed. This study will give the physician more specific information about the presence of scarring.

• #19 Vesicoureteral Reflux (VUR) | Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/v/vesicoureteral-reflux

  A similar test called nuclear cystogram may be used instead of the VCUG. A catheter is placed and the procedure is like the above test. […] A kidney (renal) and bladder ultrasound is a test using sound waves to look for kidney scarring and kidney size. During the ultrasound, a tech will rub warm gel on the child’s belly and back. Then, the tech will move a device, which looks like a microphone, on the same places.

• #20 Vesicoureteral Reflux and Reflux Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/tubulointerstitial-diseases/vesicoureteral-reflux-and-reflux-nephropathy

  Reflux nephropathy is renal scarring presumably induced by vesicoureteral reflux of infected urine into the renal parenchyma. The diagnosis is suspected in children with urinary tract infections or a family history of reflux nephropathy, or if a prenatal ultrasound shows hydronephrosis. Diagnosis is by voiding cystourethrography or radionuclide cystography. […] Diagnosis and staging of reflux nephropathy (prenatal or postnatal presentation) are ultimately made with voiding cystourethrography (VCUG), which can demonstrate the degree of ureteral dilation. Radionuclide cystography (RNC) can also be used; it provides less anatomic detail than VCUG but involves less radiation exposure. Renal scarring is diagnosed with technetium-99mlabeled dimercaptosuccinic acid (DMSA) radionuclide scanning. […] Testing for these patients is with radionuclide cystography or voiding cystourethrography. […] If reflux nephropathy is suspected, do ultrasonography; if abnormal, consider voiding cystourethrography or, to minimize radiation exposure, radionuclide cystography.

• #21 Vesicoureteral Reflux Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/439403-workup

  The American College of Radiology (ACR) recommends febril infants 2 months with UTIs undergo renal US. However the ACR cautions that US has low sensitivity for detecting VUR and its main benefit is the detection of congenital renal abnormalities such as hydronephrosis, duplex renal system, hydroureter, and ureterocele. […] VCUG, which provides clear anatomic detail and allows accurate grading of the degree of reflux, remains the gold standard tool to identify VUR. However, the test is usually a traumatic experience to both patients and their families due to the need for catheterization. Additionally, it carries a risk of introducing infection into the urinary tract. […] The recommended radiographic evaluation for VUR includes a voiding cystourethrography (VCUG), a renal-bladder ultrasonography, and a nuclear renal technetium-99mlabeled dimercaptosuccinic acid (DMSA) scan.

• #22 SciELO Brazil – Brazilian consensus on vesicoureteral reflux–recommendations for clinical practice Brazilian consensus on vesicoureteral reflux–recommendations for clinical practice

  https://www.scielo.br/j/ibju/a/k74v7s3c8GYZBh5DWRYFRbL/

  The main advantage of VCUG over Direct Isotopic Radionuclide Cystography is related to the anatomical detail. […] Therefore, VCUG remains the gold standard diagnostic test and initial evaluation of VUR. […] The panel believes that a careful and meticulous clinical history considering all aspects discussed above and with special attention to LUTD should be obtained prior to any imaging test. […] The indication for VCUG may vary according to the clinical presentation of the patient and some protocols have been proposed for this purpose. […] The indication of a VCUG in the evaluation of a child presenting UTI is still controversial. […] VCUG is recommended in newborns with postnatal ultrasound findings of bilateral grade II to IV and unilateral grade III to IV hydronephrosis. […] Routine investigation of asymptomatic siblings and/or children of patients with VUR is controversial.

• #23 Vesicoureteral Reflux | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/urology/conditions-treated/vesicoureteral-reflux/

  Vesicoureteral reflux (VUR) is the backup of urine from the bladder (organ that stores urine) into the ureter (tube that carries urine from the kidney to the bladder) during urination. VUR may result in urine reflux into the renal pelvis, causing distention (hydronephrosis) and kidney damage. […] VUR is commonly diagnosed during infancy or childhood as a result of a urinary tract infection (UTI). UTI is diagnosed using urinalysis and urine culture. VUR that causes hydronephrosis is often diagnosed during prenatal ultrasound. A cystogram (also called cystourethrogram) and a voiding cystourethrogram (VCUG) are performed to determine if an abnormality in the urinary tract is causing reflux. In these procedures, a contrast dye is instilled into the bladder through a catheter and a series of X-rays are taken. […] Other diagnostic tests used to diagnose VUR include the following: Bladder ultrasound (to detect abnormalities that cause reflux) Renal ultrasound and renal scan (to evaluate hydronephrosis, kidney growth, and scarring) Urodynamic studies (e.g., filling cystometrogram, voiding cystometrogram).

• #24 How is VUR diagnosed and graded? – Deflux

  https://deflux.com/hcp/vesicoureteral-reflux/diagnosing-grading-vur/

  However, a 2013 study of children with their first UTI and normal RBUS shows that in 24% of patients, VUR would not have been detected. […] The same study shows that 15% of these children had recurrent pyelonephritis and 7% went on to surgical intervention. […] RBUS may not detect VUR after a first UTI […] More severe VUR is associated with a lower chance of spontaneous resolution and more severe renal scarring and increased complications […] The International Classification System for VUR: […] Consider referring a patient to a pediatric urologist for the following: […] Individualized management of VUR.

• #25 Vesicoureteral reflux (VUR): symptoms, diagnosis and treatments

  https://www.kidneyresearchuk.org/conditions-symptoms/vesico-uretal-reflux/

  Vesico-ureteric reflux (VUR) is a condition in which urine travels back up the tubes connecting the kidneys to the bladder (known as the ureters) towards the kidney. […] VUR can also occur when the pressure in the bladder gets too high, most commonly when there is a blockage. […] VUR may be suspected if you or your child has frequent or severe UTIs. […] An ultrasound scan is often used to look for evidence of abnormal enlargement (dilatation) within the kidneys or ureters and to see if your or your child’s bladder is emptying fully. […] However, other scans and tests are usually required to make a firm diagnosis of VUR: […] A bladder X-ray – also known as a micturating cysto-urethrogram (MCUG). […] A mercapto acetyl tri-glycine reflux (MAG 3) test. […] A dimercapto succinic acid (DMSA) scan – can sometimes be used to highlight any damage or scarring of the kidneys. […] Additional blood and urine tests will also be used to gauge your or your child’s kidney function and look for the presence of protein in the urine – a sign of kidney damage.

• #26 What Is VUR? | Unsilenced Movement

  https://www.unsilencedmovement.com/about-vur

  Another effective diagnostic method is contrast-enhanced voiding urosonography (ceVUS), a radiation-free imaging test that utilizes ultrasound instead of ionizing radiation. […] ceVUS is not only more cost-effective for families, but also has an equal or superior diagnostic value to VCUG. […] Additional diagnostic techniques include: […] DMSA renogram […] Renal MAG3 scan […] Computed tomography (CT) urogram […] PIC cystogram (positioned instillation of contrast cystogram)

• #27

  https://journals.lww.com/heur/fulltext/2022/34030/vesicoureteral_reflux___insights_into_diagnosis.6.aspx

  Vesicoureteral reflux (VUR) is the most common congenital condition of the urinary tract. The aim of this article is to analyze the available diagnostic tests and the pharmaceutical, endoscopic, and surgical options of our therapeutic armamentarium. Regarding the mostly used imaging tests, voiding cystourethrography is considered the reference method for the diagnosis and grading of the disease, but it entails exposure of patients to ionizing radiation. Voiding urosonography has a similar sensitivity but is highly dependent on the operators experience. The initial detection of primary VUR is in many cases prompted by the diagnosis of a febrile UTI. In children with complicated/febrile UTI and/or comorbidities, VUR is considered a significant possible diagnosis that is worth actively searching for to be treated. The assessment of grade is also highly important as children with higher grades of VUR and UTI are at increased risk for developing pyelonephritis and renal scars. VCUG is considered the gold standard but due to its cost and concerns of exposure to ionizing radiation, other imaging modalities that are less expensive and are related to less exposure to radiation, such as the contrast-enhanced US, have been explored as a tool for the assessment of VUR. Voiding Cystourethrogram (VCUG) with fluoroscopy remains the gold standard in the detection and evaluation of VUR among children, as it yields images of the bladder and urethra and in addition enables grading of the reflux. Ultrasound is recommended by widely used clinical practice guidelines as the initial diagnostic testing for the first UTI in children with high suspicion of VUR. However, ultrasonography has not been proven to be either sensitive or specific in detecting reflux. Several publications have concluded that sonography remains an inferior screening test in children with febrile UTI as it is technician dependent, does not provide assessment of renal function and is not sensitive enough to detect all scarring. Voiding urosonography is more sensitive and specific than RBUS. It is an investigation of the urinary tract with intravesical administration of contrast agents. 99 mTc-dimercaptosuccinic acid (DMSA) scintigraphy is a radionuclide scan performed to detect pyelonephritis and renal scars and is considered the gold standard. Contrast-enhanced voiding urosonography-harmonic imaging (CEVUS-HI) is also considered highly accurate in detecting VUS among children. Magnetic resonance urography (MRU) can differentiate congenital renal dysplasia from acquired renal damage thanks to the improved spatial and contrast resolution, and also offers the opportunity of grade assessment as there is a proven association between damage in MRU and VUR grade. The ultimate goal on which VUR management should be focused has been a long-debated issue. Some publications insist on the anatomical correction or improvement of reflux perse, while others highlight the importance of reducing the morbidity of recurrent UTIs and the long-term sequelae of renal damage. The common objective of all definitive treatment options is the anatomical correction of VUR. Taking into consideration that the resolution of reflux seems to no longer be the ultimate goal, assessing both the necessity and the success of these procedures and tailoring the available options for the needs of each patient is crucial. Definitive treatment is strongly recommended for persistent high-grade (IV/V) VUR, yet there is no consensus on proper timing. Open ureteral reimplantation is still considered the gold standard for definitive treatment of VUR, with success rates in the anatomical correction that consistently surpass 95%. Robotic ureteral reimplantation has seen a rise in popularity, as expected, over the past decade. It offers lower overall morbidity, a shorter hospital stay, and multiple degrees of freedom of movement for the surgeon. Despite the multiple benefits laparoscopic and robotic surgery supposedly offer, their advantage over open surgery is still debated, so no general recommendation for them is currently included in official guidelines.

• #28 Vesicoureteral Reflux: Classification, Diagnosis, and Treatment

  https://www.urology-textbook.com/vesicoureteral-reflux.html

  Vesicoureteral reflux (VUR) is a common congenital or acquired disorder of the vesicoureteral junction with reflux of urine into the upper urinary tract, which can lead to recurrent urinary tract infections, pyelonephritis with scarring, arterial hypertension, and chronic renal insufficiency. […] The prevalence of VUR in non-symptomatic children is around 1%. […] LUTS with high micturition pressures (dysfunctional micturition, urethral valves, neurogenic lower urinary tract dysfunction such as spina bifida) are a strong risk factor for high-grade vesicoureteral reflux with renal scarring. […] VCUG is the most important imaging tool for detecting vesicourethral reflux. […] VCUG should only be done after sufficient treatment of urinary tract infection (at least 710 days after pyelonephritis); otherwise, there is a risk of false positive results.

• #29 Azthena logo with the word Azthena

  https://www.news-medical.net/health/How-is-Vesicoureteral-Reflux-Diagnosed.aspx

  The backward flow of urine from the bladder to the ureters is called vesicoureteral reflux (VUR) and it is a medical condition mostly seen in the pediatric population. […] In order to diagnose VUR, a series of tests is usually required. Laboratory investigations including urinalysis may be ordered to confirm the presence of a UTI. Urine analysis is supplemented by the use of imaging tests, which form the basis of the entire investigation into the cause of VUR. […] Urodynamic studies are done with the help of a manometer which measures the pressure inside the bladder, thus helping to assess its functioning. […] Imaging is important to detect any underlying structural abnormalities of the urinary system. An ultrasound of the kidneys, ureters and bladder (KUB) employs the use of sound waves at a high frequency to produce an image of the internal structures. […] In addition to sonography, a voiding cystourethrogram (VCUG) may also be done, whereby the radiologist uses intravesicular contrast dye and takes X-rays of the bladder in various positions while it is filling and emptying.

• #30 The Diagnosis and Treatment of Vesicoureteral Reflux: An Update

  https://openurologyandnephrologyjournal.com/VOLUME/8/PAGE/96/

  The challenge in the evaluation and management of VUR is primarily due to the lack of consensus on which patients to screen and which patients require treatment. […] The EAU acknowledges that the degree of HN is not a reliable indicator of VUR. However, VCUG is recommended for those with bilateral high-grade HN, duplex kidneys with HN, ureterocele, ureteral dilation or abnormal appearing bladders. […] The 2011 revised AAP Guidelines on the management of UTI no longer recommend automatic VCUG testing following a UTI. Instead, the AAP recommends a VCUG following recurrent febrile UTIs or a renal/bladder abnormality on ultrasound showing hydronephrosis, hydroureter or evidence of renal scarring. […] The latest AUA VUR guidelines recognize this concomitant relationship between VUR, UTIs, and BBD.

• #31 Vesicoureteral Reflux | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/vesicoureteral-reflux

  It’s especially important to promptly diagnose and treat VUR in infants and small children, since without treatment most of them will develop another urinary tract infection. Waiting until a child has had two or more urinary tract infections before having an evaluation increases the risk of permanent kidney damage or scarring. […] Vesicoureteral reflux is usually diagnosed in one of two ways. Children who have a urinary tract infection that’s been confirmed by a lab test will have an X-ray evaluation called a voiding cystourethrogram. During the test, the bladder is filled with contrast material that shows up on X-rays. If the child has VUR, the contrast material will backflow into the ureter and kidneys. […] Alternately, VUR may be suspected when a prenatal ultrasound reveals that the fetus has dilated kidneys. If this occurs, a voiding cystourethrogram is done soon after the birth of the baby. […] Reflux is graded on a scale of one to five, with one being a mild form and five being severe. The degree of reflux is used to make decisions on how to treat the child. More severe grades are less likely to clear up spontaneously and more likely to cause kidney damage if they’re not treated.

• #32 Vesicoureteral Reflux (VUR) in Infants & Children | National Kidney Foundation

  https://www.kidney.org/kidney-topics/vesicoureteral-reflux-vur-infants-children

  About 1-3% of all infants and children have a condition called vesicoureteral reflux (VUR), which means some of their urine flows in the wrong direction after entering the bladder. […] That’s why it’s important to diagnose and monitor VUR early and treat it if needed. […] VUR is diagnosed by a test called a voiding cysto-urethrogram (VCUG). A VCUG is usually done if: a child has had one UTI with fever and a kidney ultrasound shows a problem. […] X-rays are taken as the bladder fills up. VUR is diagnosed if the liquid goes the wrong way up a ureter and back into a kidney. […] VUR is graded between 1 (mild) to 5 (worst). The grade is based on how far the urine backs up and how wide the ureter is. […] Treatment for VUR is based on a child’s age, the grade of their VUR, and whether it’s causing any problems, such as a lot of UTIs.

• #33 Pediatric Vesicoureteral Reflux – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/vesicoureteral-reflux

  Your opinion or preference. […] Most children who have grade 1 through 3 VUR do not need any type of intense therapy. […] The reflux resolves on its own over time, usually within five years. […] Children who develop frequent fevers or infections may require ongoing preventive antibiotic therapy and periodic urine tests. […] Surgical treatment is also available. […] Children who have grade 4 and 5 reflux may require surgery. […] During the procedure, the surgeon will create a flap-valve apparatus for the ureter that will keep the urine from flowing into the kidney. […] The procedure can be performed through endoscopic surgery, open surgery or robot-assisted laparoscopic surgery.

• #34 Mini-review on pathogenesis and diagnosis of vesicoureteral reflux in children – MedCrave online

  https://medcraveonline.com/UNOAJ/mini-review-on-pathogenesis-and-diagnosis-of-vesicoureteral-reflux-in-children.html

  Vesicoureteral reflux (VUR) represents nowadays a controversial issue regarding its diagnosis, screening and treatment for its potential renal damage is not clearly understood. […] The purpose of this mini-review is to analyze the pathogenesis of VUR, trying to understand its etiologies and then evaluate evidence in its screening and diagnosis. […] Guidelines concerning initial evaluation of VUR differ among organizations. Controversies exist for the real clinical course of VUR is not well known. […] The American Academy of Pediatrics (AAP) has changed its recommendation of 1999 when RBUS and VCUG were indicated after a first episode of febrile UTI for the diagnosis of VUR. […] The European Society for Pediatric Urology (ESPU) and the EAU recommend for VCUG in addition to RBUS, considering that early diagnosis may prevent bad prognosis of VUR. […] The present mini-review explains pathogenesis of VUR and emphasizes controversy and different guidelines regarding VUR imaging, screening and initial diagnosis.

• #35 Current Medical Diagnosis and Management of Vesicoureteral Reflux in Children

  https://brieflands.com/articles/num-17084

  Vesico-ureteral reflux (VUR) is presented in approximately %1 of children and is associated with an increased risk of pyelonephritis and renal scarring. […] Despite its prevalence and morbidity, many aspects of VUR diagnosis and treatment are controversial. […] Recent studies have focused on developed determination of VUR-related renal morbidity, improved stratification tools that children would benefit most from which VUR treatment option, and improved reporting of the long-term outcomes of VUR treatments in children who are at risk for VUR. […] The aim of the initial evaluation after a febrile UTI is (1) to prevent recurrent febrile UTI, (2) renal damage, and (3) to minimize morbidity. […] The EAU (European association of urology) and the ESPU (European society of pediatric urology) guidelines recommend urinary system ultrasonography (USG) and voiding cystourethrography (VCUG) for the initial assessment.

• #36

  https://link.springer.com/article/10.1007/s00467-006-0396-8

  In conclusion, there are two strategies for the initial investigation of children below 2 years of age with a first febrile UTI. […] The first recommends a DMSA scan and a US, and only children with renal lesions on DMSA scan or with recurrent febrile UTIs should be evaluated with a VCUG or RNC. […] The alternative strategy adopted by many clinically oriented pediatric nephrologists is the use of a VCUG or RNC and a US for the initial investigation of these patients.

• #37 Vesicoureteral Reflux Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/439403-workup

  The DMSA scan is used to confirm suspected pyelonephritis and to evaluate the effectiveness of VUR medical management. […] Several authors have advocated DMSA renal scan as the first study following a febrile UTI. Patients found to have renal lesions on DMSA were found to have a higher incidence of UTIs and VUR, thus preselecting patients who needed to undergo VCUG (top-to-bottom approach to the evaluation of VUR).

• #38 Vesicoureteral Reflux: Practice Essentials, Background, Relevant Anatomy

  https://emedicine.medscape.com/article/439403-overview

  Vesicoureteral reflux (VUR) is defined as retrograde regurgitation of urine from the urinary bladder up the ureter and into the collecting system of the kidneys. It is the end result of several anomalies related to the functional integrity of the ureter, the dynamics of the bladder, and the anatomic composition of the ureterovesical junction (UVJ). […] Early diagnosis and vigilant monitoring of VUR are the cornerstones of management but controversy surrounds the starting point of the evaluation for VUR. Guidelines conflict on whether to focus on assessing the condition of the kidneys (top-down) or identifying the presence of VUR (bottom-up). […] Current research efforts are directed toward better understanding of the genetics of VUR, refining the diagnostic criteria in order to better identify patients who seem to be at increased risks for kidney damage, and determining who would benefit most from definitive therapy.

• #39

  https://link.springer.com/article/10.1007/s00467-006-0396-8

  Increasing skepticism has been noted recently concerning when and for whom it is important to investigate for VUR. […] The investigation of these patients with a DMSA scan, despite the negative findings on the VCUG, may possibly lead to the prevention of long-term complications. […] In addition, an abnormal DMSA was found only in 16% of children with VUR aged less than 1 year with a normal renal ultrasound (US), and 50% of scarred kidneys did not have associated VUR. […] It has been long recognized that the chance of developing RN is much higher in younger children, with babies at greatest risk. […] The major advantage of an acute DMSA is the identification of primary lesions and their differentiation from secondary lesions, but this is not always possible. […] The use of DMSA for early investigation of young febrile children with their first UTI is not generally accepted.

• #40 Vesicoureteral Reflux Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/vesicoureteral-reflux-guideline

  Following open surgical or endoscopic procedures for VUR, a renal ultrasound should be obtained to assess for obstruction. […] The prevalence of VUR is approximately 27% in siblings of children with VUR. The screening methods to detect VUR include voiding cystourethrogram (VCUG) or radionuclide cystography. […] In siblings of children with VUR, a voiding cystourethrogram or radionuclide cystogram is recommended if there is evidence of renal cortical abnormalities or renal size asymmetry on ultrasound or if there is a history of urinary tract infection in the sibling who has not been tested. […] The presence of VUR in neonates with a history of prenatal hydronephrosis can be confirmed by performing a VCUG or radionuclide cystography.

• #41 Current Medical Diagnosis and Management of Vesicoureteral Reflux in Children

  https://brieflands.com/articles/num-17084

  The EAU, ESPU and AUA (American urological association) guidelines reported that technetium 99m Tc dimercaptosuccinic acid (DMSA) scintigraphy has been recommended in patients who have high grade of VUR, high creatinine levels and intercurrent UTI. […] VUR is a familial, polygenic, autosomal dominant inherited disease. […] The EAU and the AUA guidelines recommend performing USG initially and VCUG when any abnormalities due to the increased risk are present. […] The families should be informed about the VUR risk and families who do not agree to the imaging must be warned about being ready to receive treatment for febrile UTI and the possible necessity of detailed VUR investigation. […] The SFU (society of fetal urology) and the AUA guidelines recommend VCUG if abnormal bladder findings, hydroureter and SFU grades III-IV prenatal hydronephrosis are detected on fetal ultrasonography.

• #42 Vesicoureteral reflux – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vesicoureteral-reflux/symptoms-causes/syc-20378819

  Secondary vesicoureteral reflux. This type of reflux most often happens because the bladder doesn’t empty properly. There can be many reasons for this. For example, a fold of tissue may block urine from fully leaving the bladder. Or muscles that connect the bladder to another tube called the urethra may become too narrow. Or the nerves that control the bladder’s ability to empty may become damaged. […] Kidney damage is the main health concern, also called complication, that can happen with vesicoureteral reflux. The worse the reflux, the more serious the complications are likely to be. […] Complications may include: Kidney scarring. Without treatment, UTIs can lead to lasting damage to kidney tissue known as scarring. Extensive scarring may lead to high blood pressure and kidney failure.

• #43 Vesicoureteral Reflux: A-to-Z Guide from Diagnosis to Treatment to Prevention | DrGreene

  https://www.drgreene.com/articles/vesicoureteral-reflux

  Reflux usually comes to medical attention because someone looked for it after a urinary tract infection. […] Imaging studies are needed to diagnose reflux. These are often wise to obtain in young children who have had urinary tract infections. Most will need a renal ultrasound and some will also need a cystogram called a VCUG (a study where a catheter is put into the bladder, some marker is put into the urine, and pictures are taken when the bladder contracts). […] The ultrasound is easy, and shows if there is damage to the kidney. When there is a normal ultrasound, parents often wonder why a VCUG or other cystogram is needed. The ultrasound detects kidney scarring (which the VCUG cannot), but it does not detect most reflux.

• #44 Reflux Nephropathy: Symptoms, Diagnosis, and Outlook

  https://www.healthline.com/health/reflux-nephropathy

  Reflux nephropathy results from the backward flow of urine from your bladder into your kidneys. […] This backward flow is called vesicoureteral reflux (VUR). […] Doctors usually diagnose VUR in children under the age of 2 years. […] To diagnose this condition, a healthcare professional may recommend blood and urine tests to check your kidney function. […] Imaging tests include: ultrasounds of the kidneys and bladder, abdominal CT scan, intravenous pyelogram and retrograde pyelogram, radionuclide cystogram, voiding cystourethrogram. […] Treatment in children often centers on the prevention of UTIs. […] Without treatment, reflux nephropathy can lead to CKD.

• #45 Vesicoureteral Reflux (VUR): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5995-vesicoureteral-reflux

  Managing VUR requires the help of a healthcare provider. Treatment options depend on your child’s age, symptoms, type of VUR and its severity. Treatments include antibiotics and other medications, an injectable dissolvable bulking agent, short-term catheterization and surgery. […] Primary VUR may improve with age (typically by age 5). Sometimes, a wait-and-see approach works. Other times, surgery or medications are necessary. […] Healthcare providers treat secondary vesicoureteral reflux (VUR) by removing the blockage or improving how the bladder empties.

• #46 Vesicoureteral Reflux – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK563262/

  The evaluation of prenatal hydronephrosis is primarily based on ultrasonography findings during the third trimester of pregnancy. […] A VCUG is the preferred imaging modality for diagnosing VUR, and this method is also valuable for postoperative urinary tract evaluation. […] Guidelines from the AAP recommend evaluation for VUR in patients aged 2 to 24 months after the second episode of febrile UTI or if their renal ultrasonography is abnormal. […] Medical management is usually the initial approach, reserving surgery for cases where medical management fails or is deemed unnecessary, especially in grades I and II VUR. […] If VUR persists despite medical management, surgical intervention should be considered.

• #47 Vesicoureteral Reflux Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/vesicoureteral-reflux-guideline

  Continuous antibiotic prophylaxis is recommended for the child less than one year of age with VUR with a history of a febrile urinary tract infection. This approach is based on the greater morbidity from recurrent urinary tract infections found in this population. […] Continuous antibiotic prophylaxis is recommended for the child with bladder/bowel dysfunction and VUR due to the increased risk of urinary tract infection while bladder/bowel dysfunction is present and being treated. […] Surgical intervention for VUR, including both open and endoscopic methods, may be used. Prospective randomized controlled trials have shown a reduction in the occurrence of febrile urinary tract infections in patients who have undergone open surgical correction of VUR as compared to those receiving continuous antibiotic prophylaxis.

• #48 Vesicoureteral Reflux Diagnosis & Treatment at Duke

  https://www.dukehealth.org/pediatric-treatments/pediatric-urology/vesicoureteral-reflux

  Hearing that your child may have vesicoureteral reflux (VUR) can be frightening. […] VUR is often found when a child has swelling of a kidney (hydronephrosis) due to the backward flow of urine and/or a severe UTI. […] To determine whether your child has VUR, your provider may recommend: […] Voiding Cystourethrogram (VCUG) This specialized X-ray allows providers to see what happens when your child’s bladder is filled with X-ray dye. If VUR is present, the dye will be seen going backward from the bladder up the ureters and into the kidneys. […] In many mild or low-grade cases, your child may outgrow the VUR. Treatment may include: […] For some children with severe or persistent VUR, the best option may be surgery that requires general anesthesia. This procedure can be done open, robotically, or as a minimally invasive procedure with a laparoscope to view organs with a small camera. […] Your child’s VUR treatment plan will be tailored to their specific needs with particular attention to short-term and long-term health and safety.

• #49 Pediatric Vesicoureteral Reflux – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/vesicoureteral-reflux

  Diagnostic procedures for VUR include: Renal ultrasound. This is a noninvasive test in which a probe is passed over the kidney producing sound waves which bounce off the kidney, transmitting a picture of the organ on a video screen. […] Voiding cystourethrogram (VCUG). A VCUG is an X-ray test that examines the urinary tract. […] Voiding urosonogram. This is a test that combines both features of an ultrasound and a VCUG. […] Blood tests. These are used to measure kidney function. […] A Childrens National, specific treatment for VUR will be determined by your child’s doctor based on: Your child’s age, overall health, and medical history. […] The severity or grade of reflux. […] Your child’s ability to take specific medications, procedures, or therapies. […] Possibility of the reflux going away on its own.

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