Materiały źródłowe

• #1 Vesicoureteral Reflux Treatment & Management: Approach Considerations, Active Surveillance, Medical Care

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

  Clinical management of vesicoureteral reflux (VUR) is complex and should be individualized. The main health concern in patients with VUR is the occurrence of febrile urinary tract infection (UTI) or pyelonephritis, which may lead to renal scarring, hypertension, and renal insufficiency. On the other hand, VUR has a high rate of spontaneous resolution, especially in young patients and with low-grade VUR. The goals of treatment are to minimize over-treatment in patients with low risk of UTI and to prevent renal scarring. […] Three approaches are used to treat children with vesicoureteral reflux (VUR), as follows: Active surveillance, Medical treatment, Surgical treatment. […] The philosophy of medical management is based on the knowledge that low-grade reflux resolves spontaneously and sterile reflux does not damage the kidney. Medical management involves the following: Administering long-term suppressive antibiotics, Correcting the underlying voiding dysfunction (if present), Conducting follow-up radiographic studies (eg, voiding cystourethrography [VCUG], nuclear cystography, dimercaptosuccinic acid [DMSA] scan) at regular intervals.

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

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

  Treatment options for vesicoureteral reflux depend on how serious the condition is. Children with mild primary vesicoureteral reflux may outgrow it in time. In this situation, your child’s healthcare professional may recommend a wait-and-see approach. […] For more-serious vesicoureteral reflux, treatment options include medications or surgery. […] UTIs need to be treated quickly with antibiotics. These medicines help keep the germs that cause the infection from moving to the kidneys. To prevent UTIs, healthcare professionals also may prescribe antibiotics at a lower dose than for treating an infection. […] Surgery may be needed if vesicoureteral reflux doesn’t get better with medicine. For instance, it may be a treatment option if your child keeps getting UTIs with fever. Surgery can fix the leaky valve between the bladder and each affected ureter. A valve condition keeps the valve from closing and preventing urine from flowing backward.

• #1 Contemporary Management of Vesicoureteral Reflux

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4996282/

  The past 30 years have seen broad changes in the diagnosis and management of vesicoureteral reflux (VUR). […] Our approach remains conservative. Careful follow-up, parental education about pathophysiology and management of VUR and UTI, and management of bowel and bladder dysfunction (BBD) when present, are the foundation of treatment. Additionally, though we recognize the limitation of continuous antibiotic prophylaxis (CAP), we believe the benefits outweigh the risks and costs for many patients. […] Surgical management remains a relevant option for select patients who fail conservative measures with breakthrough UTIs or failure to resolve. Minimally invasive surgical options are available with acceptable outcomes though open ureteroneocystostomy still carries the highest success rate.

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

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

  VUR can occur in varying degrees of severity. It can be very mild, when urine backs up only a short distance in the ureters. Or, it can be severe and lead to kidney infections and permanent kidney damage (scarring). A Childrens National, specific treatment for VUR will be determined by your child’s doctor based on: […] Your child’s doctor may assign a grading system (ranging from 1-5) to indicate the degree of reflux. The higher the grade, the more severe the reflux. […] 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. […] Preventive antibiotics have been shown to stop urinary infections in some cases and pose little risk of problems. They do not make your child less immune to disease or infection. The doses used are very low, just enough to prevent a urinary infection from starting. While you are waiting for the reflux to go away, it is sometimes best to keep your child on a preventive antibiotic so that they do not have more infections.

• #1 Vesicoureteral Reflux (VUR) – NIDDK

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

  Doctors treat VUR based on the childs age, symptoms, and type and grade of VUR. […] Until VUR goes away on its own, doctors treat any UTIs that develop with antibiotics, a type of medicine that fights bacteria. Treating UTIs quickly and preventing UTIs from developing will make it less likely your child will have a kidney infection. […] Your childs doctor also may consider the use of a long-term, low-dose antibiotic to prevent UTIs. Researchers have found that daily use of a low-dose antibiotic may help many children with VUR. […] Sometimes doctors will consider surgery for a child who has VUR with repeat UTIs, particularly if the child has renal scarring or severe reflux that is not improving. Doctors can use surgery to correct your childs reflux and prevent urine from flowing back to the kidney.

• #1

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

  Once reflux is identified, treatment depends on how severe the reflux is and the age of your child. Reflux is graded on a scale of 1 (mildest) to 5 (most severe). Since the milder forms may go away with time, the goal of treatment is to prevent urinary tract infection until the reflux has a chance to subside. Reflux may take several years to resolve. To prevent infection, your child may be placed on a low dose of an antibiotic once daily to prevent urinary tract infection. The 2 drugs used most often are: Cotrimoxazole (Bactrim, Septra) or Macrodantin (Furadantin, Macrobid). These drugs appear to have the fewest effects on other parts of the body. If your child is less than 2 months old, Amoxicillin is used most often. If your child has symptoms of a urinary tract infection you will need to see your pediatrician. A voiding cystourethrogram (VCUG) and an ultrasound are usually repeated every year as long as the reflux persists.

• #1 Vesicoureteral Reflux (VUR) – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-renal-and-genitourinary-anomalies/vesicoureteral-reflux-vur

  Mild to moderate vesicoureteral reflux often resolves spontaneously over months to several years. It is very important to keep children free of infection. Previously, children with mild to moderate VUR were given daily antibacterial prophylaxis, but there is currently no consensus on this practice. Most pediatric urologists recommend prophylactic antibiotics for severe VUR at all ages, for VUR grades III to V in children trimethoprim/sulfamethoxazole at bedtime, nitrofurantoin at dinnertime, or cephalexin twice daily. […] Severe vesicoureteral reflux accompanied by high intravesical pressures is treated with anticholinergic medications (eg, oxybutynin, solifenacin succinate) and rarely surgery (such as botulinum toxin injection or bladder augmentation). Patients with bowel and bladder dysfunction benefit from behavioral modification with or without biofeedback.

• #1 Vesicoureteral reflux – Wikipedia

  https://en.wikipedia.org/wiki/Vesicoureteral_reflux

  Endoscopic injection involves applying a gel around the ureteral opening to create a valve function and stop urine from flowing back up the ureter. The gel consists of two types of sugar-based molecules called dextranomer and hyaluronic acid. Trade names for this combination include Deflux and Zuidex. Both constituents are well known from previous uses in medicine. They are also biocompatible, which means that they do not cause significant reactions within the body. In fact, hyaluronic acid is produced and found naturally within the body. […] Medical treatment entails low dose antibiotic prophylaxis until resolution of VUR occurs. Antibiotics are administered nightly at half the normal therapeutic dose. The specific antibiotics used differ with the age of the patient and include: Amoxicillin or ampicillin infants younger than 6 weeks; Trimethoprim-sulfamethoxazole (co-trimoxazole) 6 weeks to 2 months. After 2 months the following antibiotics are suitable: Nitrofurantoin {57 mg/kg/24hrs}, Nalidixic acid, Bactrim, Trimethoprim, Cephalosporins. Urine cultures are performed 3 monthly to exclude breakthrough infection. Annual radiological investigations are likewise indicated. Good perineal hygiene, and timed and double voiding are also important aspects of medical treatment. Bladder dysfunction is treated with the administration of anticholinergics.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/Vesicoureteral-Reflux-in-Infants-Young-Children.aspx

  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. In many cases, VUR will get better on its own with age. […] Treatment approaches include: […] Observation: Children with lower grades of VUR may be safely watched under their doctors’ care. This usually involves regular follow-up appointments. It may include imaging tests to make sure the kidneys are growing normally. Children with VUR should have their urine tested for infection any time they develop a fever and there is no other reason for the fever, like a cold. […] Preventative antibiotics (prophylaxis): Some children are given a low dose of an antibiotic every day to decrease the risk of developing a UTI while waiting to see if they outgrow the VUR. The American Academy of Pediatrics (AAP) recommends preventative antibiotics mostly for children with higher grades of VUR (grades 3-5).

• #1 Pediatric Vesicoureteral Reflux Treatment & Management: Approach Considerations, Medical Care, Endoscopic Injection Therapy

  https://emedicine.medscape.com/article/1016439-treatment

  Virtually all children with a new diagnosis of grade I-IV reflux, as well as some with grade V, are given a trial of medical treatment. […] Given that a substantial number of children experience spontaneous resolution of VUR (50-85% of cases with grade I-III), medical treatment spares this group the morbidity of surgery while protecting the kidneys from further damage. […] The role of antibiotic prophylaxis in this setting has been challenged. […] In 2014, the results of the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) study were published. […] The most dramatic change in the management of VUR has been the rapid growth of endoscopic treatment. […] Some clinicians advocate endoscopic treatment as initial management for newly diagnosed VUR, arguing that immediate antireflux treatment obviates the need for long-term antibiotics and repeated imaging studies.

• #1 Urinary Reflux (VUR) and Continuous Antibiotic Prophylaxis

  https://deflux.com/en_AU/hcp/treating-vur/antibiotics/

  Continuous antibiotic prophylaxis (CAP) does not treat urinary reflux. According to the American Urologic Association (AUA), the primary goal of VUR management is to prevent febrile UTIs (fUTIs), prevent renal injury and minimize follow-up and morbidity. Antibiotic prophylaxis does not treat VUR, rather, it is used to treat bacteria in the urine (UTIs) that can cause renal scarring. Low dose, continuous antibiotic prophylaxis (CAP) decreases the offs of UTI development in children with reflux; however, evidence is conflicting with regard to CAP and prevention of renal scarring. Only 17% of paediatric VUR patients on CAP were compliant with therapy. Of patients on CAP therapy, 58% had a diagnosis of a UTI within 1 year of treatment. Continuous antibiotic prophylaxis did not prevent the recurrence of infection or the development of renal scars. The results from the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial show that antibiotic prophylaxis may not prevent kidney scarring, a primary goal of VUR treatment. Deflux offers immediate protection from further renal damage without the need for adherence to a long-term treatment regiment.

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

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

  After reflux surgery, there may be limits on physical activity. This will be based on what your surgeon decides. Voiding every two to three hours as well as drinking adequate fluids helps healing. Your child may return to school the day after surgery. […] Healthy bladder habits are vital. These include drinking an adequate amount of water and avoiding bladder irritants in the diet. Good perineal hygiene, even more so in girls, along with voiding every three to four hours, helps to prevent urinary tract infections.

• #1 Vesicoureteral reflux – Wikipedia

  https://en.wikipedia.org/wiki/Vesicoureteral_reflux

  The goal of treatment is to minimize infections, as it is infections that cause renal scarring and not the vesicoureteral reflux. Minimizing infections is primarily done by prophylactic antibiotics in newborns and infants who are not potty trained. However, in children who are older, physicians and parents should focus on bowel and bladder management. Children who hold their bladder or who are constipated have a greater number of infections than children who void on a regular schedule. When medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive renal scarring then surgical interventions may be necessary. Medical management is recommended in children with Grade I-III VUR as most cases will resolve spontaneously. A trial of medical treatment is indicated in patients with Grade IV VUR especially in younger patients or those with unilateral disease. Of the patients with Grade V VUR only infants are trialled on a medical approach before surgery is indicated, in older patients surgery is the only option.

• #1 Endoscopic Vesicoureteral Reflux Treatment Outcomes in Patients with Voiding Dysfunction

  https://clinmedjournals.org/articles/iauc/international-archives-of-urology-and-complications-iauc-5-052.php?jid=iauc

  Management of VD reduces the requirement of surgical intervention by reducing the rate of UTI and leads to downgrading or complete resolution of VUR. Treatment for VD before the endoscopic treatment may provide increase in success rates. Therefore, in VUR treatment, patients should be informed for importance of compliance to medical treatment for VD, and if endoscopic injection treatment is being planned, a regular treatment must be provided for at least 6 months before the procedure. It should be remembered that success rates may be low despite proper VD treatment, and surgical approaches should be in the forefront if necessary.

• #1 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 goals of managing VUR include preventing future febrile urinary tract infections [FUTI], renal scarring, reflux nephropathy and hypertension. […] Antibiotic prophylaxis is a safe and effective modality to sterilize the urinary tract. […] Endoscopic treatment of VUR is an attractive modality in select patients, although some concerns remain regarding its effectiveness and durability as compared to the gold standard of open or laparoscopic ureteroneocystostomy. […] The latest AUA VUR guidelines recognize this concomitant relationship between VUR, UTIs, and BBD. […] The guidelines recommend treatment of BBD prior to any surgical treatment of VUR. […] In contrast to endoscopic correction, open ureteral reimplantation can be quite successful in the treatment of VUR in children, regardless of the presence of BBD.

• #1 Vesicoureteral Reflux Treatment & Management: Approach Considerations, Active Surveillance, Medical Care

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

  The philosophy of surgical management is based on the knowledge that high-grade reflux and persistent reflux in adolescents is not likely to resolve with continued medical therapy, especially in grade III reflux or greater. […] Relative indications for surgical management of VUR include the following: Grades IV and V reflux, Persistent reflux despite medical therapy (beyond 3 y), Breakthrough UTIs in patient who are receiving antibiotic prophylaxis, Lack of renal growth, Multiple drug allergies that preclude the use of prophylaxis, A desire to terminate antibiotic prophylaxis (either by the physician or the patient/parents), Medical noncompliance. […] Absolute indications for surgical management include the following: Breakthrough pyelonephritis, Progressive renal scarring in patients receiving antibiotic prophylaxis, An associated ureterovesical junction abnormality.

• #1 Vesicoureteral Reflux Treatment & Management: Approach Considerations, Active Surveillance, Medical Care

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

  Surgery (ureteral reimplantation or ureteroneocystostomy) is the definitive method of correcting primary reflux, especially in the setting of anatomic abnormalities. […] Standard antireflux ureteral reimplantation procedures include the transtrigonal (Cohen), intravesical (Leadbetter-Politano), and extravesical detrusorrhaphy (Lich-Gregoir) techniques. The common goal of these operations is to prevent VUR by creating an effective flap-valve mechanism at the ureterovesical junction. […] The principle of this procedure is to inject, under cystoscopic guidance, a biocompatible bulking agent underneath the intravesical portion of the ureter in a submucosal location. […] Dextranomer/hyaluronic acid (Deflux, Q-Med USA) is the only FDA-approved endoscopic treatment of VUR in children. An initial clinical trial showed that this method was effective in treating reflux. […] Complications due to ureteral reimplantation of the ureters occur in less than 1% of cases, and include the following: Bleeding in the retroperitoneal space, Infections, Ureteral obstruction, Injury to adjacent organs, Persistent reflux.

• #1 Endoscopic Treatment of Vesicoureteral Reflux FAQ | Patient Education | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/education/endoscopic-treatment-of-vesicoureteral-reflux-faq

  In endoscopic treatment of vesicoureteral reflux, or VUR, the doctor uses a special viewing device, called a cystoscope, to see inside the bladder. The cystoscope is inserted through the urethra, the opening through which urine leaves the body. Then the doctor injects a small amount of a substance, called Deflux, into the wall of the bladder near the opening of one or both ureters, the tubes that carry urine from the kidney to the bladder. This creates a bulge in the tissue, making it harder for the urine to flow back up the ureter to the kidneys. There are no incisions made in the abdomen for this procedure. […] Presently, a substance called Deflux is the only injectable material approved by the U.S. Food and Drug Administration (FDA) for this procedure; others are undergoing clinical trials and have been used in other parts of the world for many years. Deflux is a gel-like liquid made of two complex sugars, dextranomer and hyaluronic acid. These sugars aren’t harmful to the body’s tissues.

• #1 Endoscopic Treatment of Vesicoureteral Reflux FAQ | Patient Education | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/education/endoscopic-treatment-of-vesicoureteral-reflux-faq

  The hyaluronic acid in Deflux is a chemical that naturally occurs and breaks down in the body. The dextranomer in Deflux remains and is slowly replaced by the body’s own tissues, forming a little bulge. The bulge makes it harder for the urine to flow back up the ureter and to the kidney. The bulge is permanent and corrects the reflux. […] Treatment with Deflux has a higher success rate for those with lower grades of reflux. One study reported a 95 percent success rate for grade II reflux, 71 percent success rate for grade III and 43 percent success rate for grade IV reflux. Similarly, a second study reported an 87 percent success rate for grade II reflux, a 75 percent success rate for grade III and 41 percent success rate for grade IV reflux. In another study, researchers reported a 78 percent success rate for both grades II and III reflux, and 66 percent success rate for grade IV reflux.

• #1 Endoscopic Treatment of Vesicoureteral Reflux FAQ | Patient Education | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/education/endoscopic-treatment-of-vesicoureteral-reflux-faq

  Based on the success rates, this procedure is recommended for children with grade II, grade III, and possibly grade IV reflux. The treatment should not be used in patients who have: […] Preparation for the procedure takes about an hour, and the procedure itself takes about 30 minutes. Your child will be put to sleep with a general anesthetic for the procedure. You can be with your child as he or she recovers. […] There may be some blood in your child’s urine, and your child may experience some mild pain when urinating. This is normal. However, if your child has any of the symptoms described below, call the Pediatric Urology office at (415) 353-2200 immediately: […] We will perform a follow-up kidney and bladder ultrasound a month after the procedure, and possibly a bladder scan in six months.

• #1 Vesicoureteral Reflux in Kids | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/vur/

  […] […] One type of surgical treatment is endoscopic surgery, also known as the deflux procedure. The surgeon will insert an instrument called a cystoscope into the bladder. Once inside the bladder, the surgeon will inject a substance into the area where the ureter meets the bladder. This is done to change the angle of the ureter entering the bladder and correct the VUR. This type of treatment is very easy, but not quite as successful as open reimplantation. The child will require general anesthesia for this procedure, but it is an outpatient surgery. […] […] […] Open reimplantation is a surgical treatment that is performed under general anesthesia through an incision in the lower abdomen, or by minimally invasive surgery. The procedure consists of correcting the flap-valve attachment of the ureter to the bladder in order to stop reflux from occurring. No artificial material is used in this procedure. A catheter will be used to drain the bladder for a few days following surgery and the child will have a short recovery stay in the hospital.

• #1 Contemporary Management of Vesicoureteral Reflux

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4996282/

  Currently, a large academic discussion has focused on the utility of antibiotic prophylaxis in children with VUR. […] Recently, two large randomized studies were published that demonstrated the benefit of CAP in preventing UTIs in children with VUR. […] The aim of surgical management is to prevent VUR by elongating the intramural tunnel of the ureter or altering the shape or angle of the ureteral orifice to allow coaptation during bladder filling. Open surgical ureteroneocystostomy (UNC) continues to be the gold standard for correction of VUR. […] Open ureteroneocystostomy (UNC) is considered the gold standard in treatment due to its high surgical success rate and low complication rate. […] Recently both laparoscopic and robotic assisted laparoscopic ureteroneocystostomy (LUNC / RALUNC) have been introduced as viable surgical treatment options for VUR.

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

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

  Our main goal is to treat vesicoureteral reflux and prevent infections that might affect the kidneys and possibly cause kidney damage. Our specialists provide a comprehensive approach to the management of vesicoureteral reflux from initial diagnosis to treatment and follow-up care. […] Many children with VUR will outgrow the condition on their own. Therefore, we do not perform surgery as initial treatment in most children. Some children, however, will require surgery to correct VUR. The most common reasons for proceeding with surgical correction of VUR are repeated UTI with kidney involvement, failure of VUR to resolve on its own over time, or severe VUR that is very unlikely to resolve. […] During the open ureteral reimplantation, the surgeon makes an incision in the lower abdomen and exposes the bladder. The junction of the bladder and the ureter (the tube connecting the bladder to the kidney) is reconstructed to prevent urine from flowing backward up into the kidney. A catheter is left in the bladder to drain the urine for the first one to two days after surgery.

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

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

  Surgery would be performed if your child has more severe reflux, fever-causing urinary tract infections despite being on antibiotics, and signs of kidney damage due to repeated infections. […] In the surgical procedure, the refluxing ureter is repositioned or re-implanted in the bladder wall. The end of the ureter is surrounded by bladder muscle in this new position in the bladder, which prevents urine from „backing up” or refluxing toward the bladder. […] Your child will be in the hospital for three to four days. After the surgery, your child will still need to take antibiotics daily until the bladder and ureter are healed. An ultrasound will be performed about a month after surgery and, depending on the case, a voiding cystourethrogram may be performed six months following surgery.

• #1 Vesicoureteral reflux (VUR): ERKNet dla Pacjentów

  https://www.erknet.org/patients/pl/your-kidney-disease/vesicoureteric-reflux/disease-information

  When medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive scarring the surgical interventions may be necessary. […] Open surgery is the gold standard and outperforms other treatments. […] Robot-assisted laparoscopic ureteral reimplantation (RALUR) is a newer technique. Its advantages are minimal invasion, less postoperative pain and shorter hospital stay than conventional open surgery. Its results are as good as those of conventional surgery.

• #1 Vesicoureteral Reflux | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/vesicoureteral-reflux/

  Lurie Children’s is one of only a few medical centers to offer robot-assisted laparoscopic surgery as an option for correcting urinary reflux. Our experienced urology surgeons and treatment teams use the da Vinci robot-assisted laparoscopic surgery to provide minimally invasive, state-of-the-art care. Current data are very promising and show that the success rate of robot-assisted laparoscopic surgery to correct VUR is more than 95 percent.

• #1 Expert Insights on Correcting Urinary Reflux in Infants and Young Children – Advances in Pediatric Urology | NewYork-Presbyterian

  https://www.nyp.org/advances/article/pediatric-urology/expert-insights-on-correcting-urinary-reflux-in-infants-and-young-children

  There are two commonly used open bladder surgical techniques: Cohen cross-trigonal and Politano-Leadbetter ureteral reimplantation, in which the ureter is detached from the bladder and then re-implanted with a longer tunnel to prevent reflux. […] Therefore, when I perform an open bladder re-implant, my preference is the Politano-Leadbetter approach as I will always have access to the upper tracts from below. […] Another option, notes Dr. Poppas, is an extravesical approach for correcting the reflux from outside of the bladder. […] In my opinion, if the goal of correcting simple primary reflux is to make the tunnel longer, approaching from outside of the bladder makes the most sense. […] The procedure is always performed as an outpatient and the child can go home without a catheter and without a drain. […] For these reasons, the extravesical approach is my preferred method of correcting reflux. […] Some pediatric urologists will perform the extravesical correction procedure robotically. […] Compared to the robotic extravesical approach, open extravesical is less invasive, less painful, and offers a faster recovery without an overnight stay in the hospital, says Dr. Poppas.

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

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

  Each year, we evaluate and treat nearly 800 children with VUR. Our goal is to prevent kidney damage and kidney infections. […] Lower grades of reflux will often resolve on their own, typically at 5 to 6 years of age. The goal is to prevent UTIs and kidney damage while the reflux is improving. […] Antibiotic prophylaxis: It has been the gold standard of care to keep children on a very low dose of antibiotics to inhibit the growth of bacteria (not to correct the VUR). This is called antibiotic prophylaxis. Antibiotics are continued until the risk of reflux is considered low. […] Surgical intervention: 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. […] Many factors should be considered when deciding about what treatment is best for your child: the severity of the reflux, whether the reflux is in one or both ureters, your child’s age and gender and the presence of kidney damage. We will thoroughly discuss all options with you and your child.

• #1 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. […] When intervention with the intention to cure VUR is being considered, open and endoscopic surgical techniques are available with differences in morbidity and success. The resolution rate per 100 children was 98.1 for open surgery and 83.0 for endoscopic therapy after a single injection of bulking agent. […] It is recommended that a plan be provided to the family/patient and the primary care physician regarding monitoring for the long-term potential issues related to VUR.

• #1 Vesicoureteral Reflux | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/vesicoureteral-reflux/

  Vesicoureteral reflux (VUR) is a relatively common condition in which urine backs up from the bladder into the kidneys. […] Physicians have significantly changed how they treat reflux in recent years. Urologists are operating on children with reflux much less often as most children will either outgrow their reflux or reach a point where it is no longer a clinical concern. […] In the past decade, treatment trends have veered away from surgery whenever possible. We now know that most cases of low- and medium-grade reflux will eventually resolve without surgery. Children with high-grade reflux may need surgery, but we will most likely recommend trying medical therapy first. […] Reflux is only harmful in the presence of a bladder infection when the infection can spread from the bladder to the kidney so our top priority in medical management is to prevent bladder infections. We will prescribe a low-dose antibiotic, which is usually given once a day, to prevent UTIs.

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

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

  The recommendation for surgical treatment is a shared-decision-making process involving the parents/guardians and physician. […] Endoscopic therapy is an attractive, minimally invasive, outpatient, surgical option in the treatment of VUR. […] Open neoureterocystotomy or ureteral reimplantation is the gold standard for surgical correction of VUR. […] The success rate of open ureteral reimplantation is approximately 95% regardless of VUR grade or presence of BBD. […] The 2010 AUA Clinical Guidelines consider surgical intervention as an option in the management of VUR.

• #1 Vesicoureteral Reflux (VUR) in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/v/vesicoureteral-reflux-vur-in-children.html

  How is vesicoureteral reflux treated in a child? Treatment will depend on your childs symptoms, age, and general health. It will also depend on how bad the condition is. […] Treatment depends on the grade of reflux: […] Grades 1 to 3. Most children with grade 1 to grade 3 VUR dont need any type of intense therapy. The reflux goes away on its own over time, often within 5 years. Children who have fevers or infections often may need to take antibiotic medicine and have periodic urine tests. They may also need surgery. […] Grades 4 to 5. Children who have grade 4 or grade 5 reflux may need surgery. During the procedure, the surgeon will create a flap-valve device for the ureter. This will prevent reverse flow of urine into the kidney. In more severe cases, the scarred kidney and ureter may need to be removed. […] New treatments are being introduced for VUR. Talk with your child’s healthcare provider for more information. […] Talk with your childs healthcare providers about the risks, benefits, and possible side effects of all treatments.

• #1 New clinical evidence shifts approach to vesicoureteral reflux (VUR) care – CHOC Pediatrica

  https://care.choc.org/personalized-medicine-surgical-innovations-advance-pediatric-brain-tumor-care-2/

  New clinical evidence shifts approach to vesicoureteral reflux (VUR) care. The practice of treating vesicoureteral reflux (VUR) with follow-up tests is questioned by CHOC urologists because it’s often unnecessary. One of the most common conditions managed by pediatric urologists is vesicoureteral reflux (VUR), which occurs when urine in the bladder flows back into the ureters and/or kidneys. Recently, this approach has been questioned, and CHOC urologists have determined that repeated follow-up testing for some patient groups is often unnecessary. Our goal is to stratify patients by risk factors and severity to diagnose and treat at the appropriate level. These classifications now drive patient care at CHOC. At CHOC, repeat testing is reserved for those with persistent symptoms such as urinary tract infections with fever or those in the high-risk category. A variety of tests help diagnose VUR, including abdominal ultrasound and the gold standard, voiding cystourethrogram (VCUG). Stratified treatment for VUR begins with the least-invasive option: expectant management with behavioral modifications to ensure healthy bowel and bladder habits. In children at intermediate or high risk, a low-dose daily antibiotic may be prescribed along with an intent focus on bowel and bladder management in the toilet-trained child. Surgical intervention, such as an open ureteral reimplant or endoscopic treatment with injection of Deflux (a bulking agent to prevent urinary reflux) is also available. In general, surgical intervention is offered to those with high-grade VUR who have recurrent kidney infections and potential for further kidney damage. Our goal is to protect the kidneys and bladder. By constantly evaluating our diagnostic and treatment best practices, we force ourselves to consider whether a change in care would mean better outcomes for our patients. When supported by clinical evidence, we make the appropriate modification and VUR patients reap the benefit.

• #1

  https://journals.lww.com/ursc/fulltext/2021/32020/conservative_management_of_vesicoureteral_reflux_.3.aspx

  Vesicoureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder to the upper urinary tract (the ureters and kidneys), caused by ureterovesical junction dysfunction. […] The conservative management for VUR involves active surveillance, where the disease progression is constantly monitored along with the use of several therapeutic modalities, including bladder training, anticholinergic and alpha-blockers, UTI prophylaxis, and bladder and bowel dysfunction (BBD) management. […] Recently, conservative treatment has become more preferred than surgical treatment for VUR, mostly due to the lack of demonstrable advantages of surgery compared to conservative treatment. […] Current recommendations by the European Urological Association advocate the use of conservative treatment for the majority of VUR cases, and surgical correction of VUR is reserved for patients with high-grade (Grades IV-V) and high-risk VUR.

• #1

  https://journals.lww.com/ursc/fulltext/2021/32020/conservative_management_of_vesicoureteral_reflux_.3.aspx

  The conservative management for VUR is complex and requires individual considerations to achieve optimal results. […] Bladder training is one of the cornerstone therapies for VUR, in which patients are trained to perform complete, regular, and low-pressure urination, thus preventing reflux. […] Anticholinergics such as oxybutynin, propantheline bromide, hyoscyamine, and alpha-blockers (prazosin) have been used as an adjunctive treatment for VUR, although data on the use of these two drug classes are limited. […] Long-term antibiotic prophylaxis has been used to prevent febrile UTIs, its effect on renal scarring, and prevent UTI recurrences. […] Probiotics can be considered as alternatives or as an effective addition to antibiotic prophylaxis in patients with low-grade VUR. […] Circumcision can be one of the additional conservative therapy options for VUR in male patients, especially in under 1-year-old pediatric patients.

• #1 Contemporary Management of Vesicoureteral Reflux

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4996282/

  Endoscopic Injection for treatment of VUR is a less invasive procedure with minimal morbidity that can be performed as an outpatient procedure. […] The success rate was also found to be lower in duplicated systems compared to single systems and neuropathic bladder patients compared to patients with a normal bladder. […] Future research may allow individual risk stratification and allow targeted intervention for patients at the highest risk.

• #1 Therapy Insight: what nephrologists need to know about primary vesicoureteral reflux | Nature Reviews Nephrology

  https://www.nature.com/articles/ncpneph0610

  Vesicoureteral reflux (VUR) is the abnormal, retrograde flow of urine from the bladder to the upper urinary tract. […] Over the past 50 years, tremendous progress has been made in the diagnosis, treatment and management of VUR. […] Management of VUR in children is complex and needs to be tailored to individual patients; pediatricians, nephrologists and pediatric urologists should have the common goal of preventing renal damage. […] Surgical therapy is an important part of the armamentarium for VUR treatment, especially in patients with high reflux grades and/or concomitant anomalies of the bladder or ureter. […] Endoscopic treatment of VUR has a lower success rate than open surgery, and the long-term effects, outcomes and risks of this new technique are not established. […] The use of low-dose prophylactic antibiotics in patients with VUR is empirical and based on over 50 years of successful management of children with reflux. […] Well-designed double-blind, placebo-controlled trials are required to prove whether antibiotic prophylaxis is necessary.

• #2 Management of vesicoureteral reflux – UpToDate

  https://www.uptodate.com/contents/management-of-vesicoureteral-reflux

  Management of vesicoureteral reflux […] The management of VUR diagnosed after a urinary tract infection (UTI) will be reviewed here. […] The goals of VUR management include: […] Prevention of recurrent urinary tract infections (UTIs) […] Prevention of worsening kidney damage (eg, kidney scarring) […]

• #2 Vesicoureteral Reflux | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/vesicoureteral-reflux/

  Vesicoureteral reflux (VUR) is a relatively common condition in which urine backs up from the bladder into the kidneys. […] Physicians have significantly changed how they treat reflux in recent years. Urologists are operating on children with reflux much less often as most children will either outgrow their reflux or reach a point where it is no longer a clinical concern. […] In the past decade, treatment trends have veered away from surgery whenever possible. We now know that most cases of low- and medium-grade reflux will eventually resolve without surgery. Children with high-grade reflux may need surgery, but we will most likely recommend trying medical therapy first. […] Reflux is only harmful in the presence of a bladder infection when the infection can spread from the bladder to the kidney so our top priority in medical management is to prevent bladder infections. We will prescribe a low-dose antibiotic, which is usually given once a day, to prevent UTIs.

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

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

  Vesicoureteral reflux, or VUR, is treated either with medication or surgery, depending on the severity of the reflux, the child’s age, the number and severity of urinary tract infections and the amount of kidney damage seen on X-ray studies. […] Treatment always includes a low daily dose of antibiotics. These antibiotics are very specific for the urinary tract and have very few side effects. The goal is to prevent kidney infections until the reflux goes away or is corrected. The type of antibiotic we use will depend on your child’s age and allergies. […] Because many cases of reflux resolve on their own as the child grows, medical therapy may be all that’s needed. Medical therapy entails using antibiotics to prevent infection until the condition resolves, and monitoring your child to make sure it does resolve. […] If the reflux persists for several years without improvement, surgery may be considered. If your child continues to have fever-causing urinary tract infections despite taking antibiotics, then surgery should be considered. Again, the goal is to prevent scarring or damage from a kidney infection.

• #2 Vesicoureteral Reflux (VUR) – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-renal-and-genitourinary-anomalies/vesicoureteral-reflux-vur

  Mild to moderate vesicoureteral reflux often resolves spontaneously over months to several years. It is very important to keep children free of infection. Previously, children with mild to moderate VUR were given daily antibacterial prophylaxis, but there is currently no consensus on this practice. Most pediatric urologists recommend prophylactic antibiotics for severe VUR at all ages, for VUR grades III to V in children trimethoprim/sulfamethoxazole at bedtime, nitrofurantoin at dinnertime, or cephalexin twice daily. […] Severe vesicoureteral reflux accompanied by high intravesical pressures is treated with anticholinergic medications (eg, oxybutynin, solifenacin succinate) and rarely surgery (such as botulinum toxin injection or bladder augmentation). Patients with bowel and bladder dysfunction benefit from behavioral modification with or without biofeedback.

• #2 Expert Insights on Correcting Urinary Reflux in Infants and Young Children – Advances in Pediatric Urology | NewYork-Presbyterian

  https://www.nyp.org/advances/article/pediatric-urology/expert-insights-on-correcting-urinary-reflux-in-infants-and-young-children

  In the past, we were very aggressive at correcting urinary reflux in children because we were concerned that reflux would cause damage to the kidney, says Dix P. Poppas, MD, FACS, Chief of Pediatric Urology at NewYork-Presbyterian/Weill Cornell Medicine. […] However, when reflux is associated with a urinary tract infection that is in the bladder, it then has a direct route to infect the kidney leading to pyelonephritis. If not caught early and corrected with antibiotic treatment, reflux with infected urine can cause scarring and permanent damage to the kidneys. […] The typical long-term management for these patients would be to keep them on a prophylactic antibiotic, which reduces the risk of a urinary tract infection by 50 percent. […] If the child has ongoing breakthrough infections or, after toilet training, continues to have stable or worsening reflux, we begin to discuss correcting the reflux, continues Dr. Poppas.

• #2 Pediatric vesicoureteral reflux: treatment patterns and outcomes | Nature Reviews Urology

  https://www.nature.com/articles/ncpuro0884

  Clinical practice guidelines suggest that patients diagnosed with vesicoureteral reflux (VUR) should be started on prophylactic antibiotic therapy to prevent urinary tract infection (UTI) and potential renal scarring. The results of our study, in which we reviewed the medical and pharmacy claim data of 11,000 children under the age of 11 years with a diagnosis of VUR, reflect these guidelines, with 76% of VUR patients initiated on antibiotic therapy. […] Compliance with antibiotic therapy, however, was very poor. The overall rate of compliance was 41.4%, with only 17% of patients having antibiotic coverage over at least 80% of the year following diagnosis of VUR, and less than 10% having antibiotic coverage throughout the entire year. […] The low rates of antibiotic compliance found in our study might place patients at an increased risk of developing renal damage or recurrent UTIs. […] The results of this study, while not designed to test the efficacy of antibiotic prophylaxis, do add to the literature that questions the effectiveness of the antibiotic prophylaxis treatment strategy for VUR patients.

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

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

  After reflux surgery, there may be limits on physical activity. This will be based on what your surgeon decides. Voiding every two to three hours as well as drinking adequate fluids helps healing. Your child may return to school the day after surgery. […] Healthy bladder habits are vital. These include drinking an adequate amount of water and avoiding bladder irritants in the diet. Good perineal hygiene, even more so in girls, along with voiding every three to four hours, helps to prevent urinary tract infections.

• #2 Pediatric Vesicoureteral Reflux Treatment & Management: Approach Considerations, Medical Care, Endoscopic Injection Therapy

  https://emedicine.medscape.com/article/1016439-treatment

  Endoscopic techniques involve injection of a bulking substance into the muscular posterior wall of the ureterovesical junction (UVJ). […] In general, the rates of success (defined as resolution of VUR on postprocedural imaging) reported for endoscopic treatment have been significantly lower than those reported for open antireflux surgery. […] The decision to proceed to antireflux surgery is based on many factors, and the medical, social, and emotional needs of the patient and the family must be considered. […] Accepted indications for surgical treatment include the following: Breakthrough febrile UTIs despite adequate antibiotic prophylaxis, Severe reflux (grade V or bilateral grade IV) that is unlikely to resolve spontaneously, especially if renal scarring is present. […] Surgery for VUR should be performed by a qualified pediatric urologist who is experienced in multiple techniques, so that the surgical procedure can be tailored to the unique anatomic circumstances of the individual patient.

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

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

  The recommendation for surgical treatment is a shared-decision-making process involving the parents/guardians and physician. […] Endoscopic therapy is an attractive, minimally invasive, outpatient, surgical option in the treatment of VUR. […] Open neoureterocystotomy or ureteral reimplantation is the gold standard for surgical correction of VUR. […] The success rate of open ureteral reimplantation is approximately 95% regardless of VUR grade or presence of BBD. […] The 2010 AUA Clinical Guidelines consider surgical intervention as an option in the management of VUR.

• #2 Vesicoureteral Reflux Treatment & Management: Approach Considerations, Active Surveillance, Medical Care

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

  Surgery (ureteral reimplantation or ureteroneocystostomy) is the definitive method of correcting primary reflux, especially in the setting of anatomic abnormalities. […] Standard antireflux ureteral reimplantation procedures include the transtrigonal (Cohen), intravesical (Leadbetter-Politano), and extravesical detrusorrhaphy (Lich-Gregoir) techniques. The common goal of these operations is to prevent VUR by creating an effective flap-valve mechanism at the ureterovesical junction. […] The principle of this procedure is to inject, under cystoscopic guidance, a biocompatible bulking agent underneath the intravesical portion of the ureter in a submucosal location. […] Dextranomer/hyaluronic acid (Deflux, Q-Med USA) is the only FDA-approved endoscopic treatment of VUR in children. An initial clinical trial showed that this method was effective in treating reflux. […] Complications due to ureteral reimplantation of the ureters occur in less than 1% of cases, and include the following: Bleeding in the retroperitoneal space, Infections, Ureteral obstruction, Injury to adjacent organs, Persistent reflux.

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

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

  Surgery would be performed if your child has more severe reflux, fever-causing urinary tract infections despite being on antibiotics, and signs of kidney damage due to repeated infections. […] In the surgical procedure, the refluxing ureter is repositioned or re-implanted in the bladder wall. The end of the ureter is surrounded by bladder muscle in this new position in the bladder, which prevents urine from „backing up” or refluxing toward the bladder. […] Your child will be in the hospital for three to four days. After the surgery, your child will still need to take antibiotics daily until the bladder and ureter are healed. An ultrasound will be performed about a month after surgery and, depending on the case, a voiding cystourethrogram may be performed six months following surgery.

• #2 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. […] When intervention with the intention to cure VUR is being considered, open and endoscopic surgical techniques are available with differences in morbidity and success. The resolution rate per 100 children was 98.1 for open surgery and 83.0 for endoscopic therapy after a single injection of bulking agent. […] It is recommended that a plan be provided to the family/patient and the primary care physician regarding monitoring for the long-term potential issues related to VUR.

• #2 New clinical evidence shifts approach to vesicoureteral reflux (VUR) care – CHOC Pediatrica

  https://care.choc.org/personalized-medicine-surgical-innovations-advance-pediatric-brain-tumor-care-2/

  New clinical evidence shifts approach to vesicoureteral reflux (VUR) care. The practice of treating vesicoureteral reflux (VUR) with follow-up tests is questioned by CHOC urologists because it’s often unnecessary. One of the most common conditions managed by pediatric urologists is vesicoureteral reflux (VUR), which occurs when urine in the bladder flows back into the ureters and/or kidneys. Recently, this approach has been questioned, and CHOC urologists have determined that repeated follow-up testing for some patient groups is often unnecessary. Our goal is to stratify patients by risk factors and severity to diagnose and treat at the appropriate level. These classifications now drive patient care at CHOC. At CHOC, repeat testing is reserved for those with persistent symptoms such as urinary tract infections with fever or those in the high-risk category. A variety of tests help diagnose VUR, including abdominal ultrasound and the gold standard, voiding cystourethrogram (VCUG). Stratified treatment for VUR begins with the least-invasive option: expectant management with behavioral modifications to ensure healthy bowel and bladder habits. In children at intermediate or high risk, a low-dose daily antibiotic may be prescribed along with an intent focus on bowel and bladder management in the toilet-trained child. Surgical intervention, such as an open ureteral reimplant or endoscopic treatment with injection of Deflux (a bulking agent to prevent urinary reflux) is also available. In general, surgical intervention is offered to those with high-grade VUR who have recurrent kidney infections and potential for further kidney damage. Our goal is to protect the kidneys and bladder. By constantly evaluating our diagnostic and treatment best practices, we force ourselves to consider whether a change in care would mean better outcomes for our patients. When supported by clinical evidence, we make the appropriate modification and VUR patients reap the benefit.

• #2

  https://journals.lww.com/ursc/fulltext/2021/32020/conservative_management_of_vesicoureteral_reflux_.3.aspx

  Vesicoureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder to the upper urinary tract (the ureters and kidneys), caused by ureterovesical junction dysfunction. […] The conservative management for VUR involves active surveillance, where the disease progression is constantly monitored along with the use of several therapeutic modalities, including bladder training, anticholinergic and alpha-blockers, UTI prophylaxis, and bladder and bowel dysfunction (BBD) management. […] Recently, conservative treatment has become more preferred than surgical treatment for VUR, mostly due to the lack of demonstrable advantages of surgery compared to conservative treatment. […] Current recommendations by the European Urological Association advocate the use of conservative treatment for the majority of VUR cases, and surgical correction of VUR is reserved for patients with high-grade (Grades IV-V) and high-risk VUR.

• #2

  https://journals.lww.com/ursc/fulltext/2021/32020/conservative_management_of_vesicoureteral_reflux_.3.aspx

  The conservative management for VUR is complex and requires individual considerations to achieve optimal results. […] Bladder training is one of the cornerstone therapies for VUR, in which patients are trained to perform complete, regular, and low-pressure urination, thus preventing reflux. […] Anticholinergics such as oxybutynin, propantheline bromide, hyoscyamine, and alpha-blockers (prazosin) have been used as an adjunctive treatment for VUR, although data on the use of these two drug classes are limited. […] Long-term antibiotic prophylaxis has been used to prevent febrile UTIs, its effect on renal scarring, and prevent UTI recurrences. […] Probiotics can be considered as alternatives or as an effective addition to antibiotic prophylaxis in patients with low-grade VUR. […] Circumcision can be one of the additional conservative therapy options for VUR in male patients, especially in under 1-year-old pediatric patients.

• #2 Vesicoureteral Reflux (VUR) – NIDDK

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

  Doctors treat VUR based on the childs age, symptoms, and type and grade of VUR. […] Until VUR goes away on its own, doctors treat any UTIs that develop with antibiotics, a type of medicine that fights bacteria. Treating UTIs quickly and preventing UTIs from developing will make it less likely your child will have a kidney infection. […] Your childs doctor also may consider the use of a long-term, low-dose antibiotic to prevent UTIs. Researchers have found that daily use of a low-dose antibiotic may help many children with VUR. […] Sometimes doctors will consider surgery for a child who has VUR with repeat UTIs, particularly if the child has renal scarring or severe reflux that is not improving. Doctors can use surgery to correct your childs reflux and prevent urine from flowing back to the kidney.

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

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

  Our main goal is to treat vesicoureteral reflux and prevent infections that might affect the kidneys and possibly cause kidney damage. Our specialists provide a comprehensive approach to the management of vesicoureteral reflux from initial diagnosis to treatment and follow-up care. […] Many children with VUR will outgrow the condition on their own. Therefore, we do not perform surgery as initial treatment in most children. Some children, however, will require surgery to correct VUR. The most common reasons for proceeding with surgical correction of VUR are repeated UTI with kidney involvement, failure of VUR to resolve on its own over time, or severe VUR that is very unlikely to resolve. […] During the open ureteral reimplantation, the surgeon makes an incision in the lower abdomen and exposes the bladder. The junction of the bladder and the ureter (the tube connecting the bladder to the kidney) is reconstructed to prevent urine from flowing backward up into the kidney. A catheter is left in the bladder to drain the urine for the first one to two days after surgery.

• #2 Vesicoureteral Reflux (VUR) in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/v/vesicoureteral-reflux-vur-in-children.html

  How is vesicoureteral reflux treated in a child? Treatment will depend on your childs symptoms, age, and general health. It will also depend on how bad the condition is. […] Treatment depends on the grade of reflux: […] Grades 1 to 3. Most children with grade 1 to grade 3 VUR dont need any type of intense therapy. The reflux goes away on its own over time, often within 5 years. Children who have fevers or infections often may need to take antibiotic medicine and have periodic urine tests. They may also need surgery. […] Grades 4 to 5. Children who have grade 4 or grade 5 reflux may need surgery. During the procedure, the surgeon will create a flap-valve device for the ureter. This will prevent reverse flow of urine into the kidney. In more severe cases, the scarred kidney and ureter may need to be removed. […] New treatments are being introduced for VUR. Talk with your child’s healthcare provider for more information. […] Talk with your childs healthcare providers about the risks, benefits, and possible side effects of all treatments.

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

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

  After reflux surgery, there may be limits on physical activity. This will be based on what your surgeon decides. Voiding every two to three hours as well as drinking adequate fluids helps healing. Your child may return to school the day after surgery. […] Healthy bladder habits are vital. These include drinking an adequate amount of water and avoiding bladder irritants in the diet. Good perineal hygiene, even more so in girls, along with voiding every three to four hours, helps to prevent urinary tract infections.

• #3 Vesicoureteral Reflux Treatment & Management: Approach Considerations, Active Surveillance, Medical Care

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

  The philosophy of surgical management is based on the knowledge that high-grade reflux and persistent reflux in adolescents is not likely to resolve with continued medical therapy, especially in grade III reflux or greater. […] Relative indications for surgical management of VUR include the following: Grades IV and V reflux, Persistent reflux despite medical therapy (beyond 3 y), Breakthrough UTIs in patient who are receiving antibiotic prophylaxis, Lack of renal growth, Multiple drug allergies that preclude the use of prophylaxis, A desire to terminate antibiotic prophylaxis (either by the physician or the patient/parents), Medical noncompliance. […] Absolute indications for surgical management include the following: Breakthrough pyelonephritis, Progressive renal scarring in patients receiving antibiotic prophylaxis, An associated ureterovesical junction abnormality.

• #3

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

  Surgery may be recommended by your urologist for the following reasons: The reflux is high grade (grade 4 or 5) […] Your child continues to have urinary infections even on antibiotic treatment […] Your child is unable to take antibiotics as prescribed […] The reflux has persisted after several years or your child is reaching adolescence. […] There are three general types of surgery used to treat VUR. They are: minimally invasive endoscopic injections […] traditional open surgery […] robotic surgery. […] Ureteral reimplantation is performed by making a small incision in the lower abdomen, or making 3 or 4 small abdominal incisions and using the operating robot. We then move the ureter(s) to a new location in the bladder to fix the refluxing one-way valve. […] Your child will remain on the daily dose of antibiotics until your doctor confirms decides that it is best to stop it.

• #3 Vesicoureteral Reflux Treatment & Management: Approach Considerations, Active Surveillance, Medical Care

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

  Surgery (ureteral reimplantation or ureteroneocystostomy) is the definitive method of correcting primary reflux, especially in the setting of anatomic abnormalities. […] Standard antireflux ureteral reimplantation procedures include the transtrigonal (Cohen), intravesical (Leadbetter-Politano), and extravesical detrusorrhaphy (Lich-Gregoir) techniques. The common goal of these operations is to prevent VUR by creating an effective flap-valve mechanism at the ureterovesical junction. […] The principle of this procedure is to inject, under cystoscopic guidance, a biocompatible bulking agent underneath the intravesical portion of the ureter in a submucosal location. […] Dextranomer/hyaluronic acid (Deflux, Q-Med USA) is the only FDA-approved endoscopic treatment of VUR in children. An initial clinical trial showed that this method was effective in treating reflux. […] Complications due to ureteral reimplantation of the ureters occur in less than 1% of cases, and include the following: Bleeding in the retroperitoneal space, Infections, Ureteral obstruction, Injury to adjacent organs, Persistent reflux.

• #3

  https://journals.lww.com/ursc/fulltext/2021/32020/conservative_management_of_vesicoureteral_reflux_.3.aspx

  Vesicoureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder to the upper urinary tract (the ureters and kidneys), caused by ureterovesical junction dysfunction. […] The conservative management for VUR involves active surveillance, where the disease progression is constantly monitored along with the use of several therapeutic modalities, including bladder training, anticholinergic and alpha-blockers, UTI prophylaxis, and bladder and bowel dysfunction (BBD) management. […] Recently, conservative treatment has become more preferred than surgical treatment for VUR, mostly due to the lack of demonstrable advantages of surgery compared to conservative treatment. […] Current recommendations by the European Urological Association advocate the use of conservative treatment for the majority of VUR cases, and surgical correction of VUR is reserved for patients with high-grade (Grades IV-V) and high-risk VUR.

• #3

  https://journals.lww.com/ursc/fulltext/2021/32020/conservative_management_of_vesicoureteral_reflux_.3.aspx

  The conservative management for VUR is complex and requires individual considerations to achieve optimal results. […] Bladder training is one of the cornerstone therapies for VUR, in which patients are trained to perform complete, regular, and low-pressure urination, thus preventing reflux. […] Anticholinergics such as oxybutynin, propantheline bromide, hyoscyamine, and alpha-blockers (prazosin) have been used as an adjunctive treatment for VUR, although data on the use of these two drug classes are limited. […] Long-term antibiotic prophylaxis has been used to prevent febrile UTIs, its effect on renal scarring, and prevent UTI recurrences. […] Probiotics can be considered as alternatives or as an effective addition to antibiotic prophylaxis in patients with low-grade VUR. […] Circumcision can be one of the additional conservative therapy options for VUR in male patients, especially in under 1-year-old pediatric patients.

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

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

  After reflux surgery, there may be limits on physical activity. This will be based on what your surgeon decides. Voiding every two to three hours as well as drinking adequate fluids helps healing. Your child may return to school the day after surgery. […] Healthy bladder habits are vital. These include drinking an adequate amount of water and avoiding bladder irritants in the diet. Good perineal hygiene, even more so in girls, along with voiding every three to four hours, helps to prevent urinary tract infections.

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