Materiały źródłowe

• #1 Management of vesicoureteral reflux – UpToDate

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

  Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder into the upper urinary tract. The clinical significance of VUR has been based on the premise that it predisposes patients to acute pyelonephritis by transporting bacteria from the bladder to the kidney, which may lead to kidney scarring, hypertension, and end-stage kidney disease. […] The goals of VUR management include: […] Prevention of recurrent urinary tract infections (UTIs) […] Prevention of worsening kidney damage (eg, kidney scarring).

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

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

  VUR is a condition that affects about 1 to 3 percent of all children. However, there are certain groups of children in whom VUR is much more common, including: […] Can vesicoureteral reflux be prevented? No. However, the urinary tract infections that are often associated with VUR can be prevented with changes to toileting behaviors, management of constipation, and preventive antibiotics. […] 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.

• #3 Antimicrobial prophylaxis for vesicoureteral reflux—where will the RIVUR study lead us? | Nature Reviews Urology

  https://www.nature.com/articles/nrurol.2014.112

  Vesicoureteral reflux (VUR) affects about 30% of children presenting with a febrile UTI and has been associated with complications such as recurrent infection and renal scarring. […] Although, in some studies, antimicrobial prophylaxis has been associated with similar recurrence rates to antireflux surgery, other studies have suggested little advantage to using this approach. […] Of 607 children with VUR diagnosed after a first or second febrile or symptomatic UTI, prophylaxis with trimethoprim-sulfamethoxazole (’sulfatrim’) was associated with a substantially reduced risk of febrile or symptomatic recurrence compared with a placebo that was identical in colour, taste, smell, and consistency (12.9% versus 23.6%). […] Patients with bladder and bowel dysfunction at baseline, and those whose index infection was febrile, derived particular benefit from prophylaxis, with reductions in recurrence rates of approximately 80% and 60%, respectively.

• #4 Antibiotic prophylaxis in vesicoureteral reflux

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3676196/

  Antibiotic prophylaxis for the prevention of UTIs and watchful waiting are currently the most common treatments for VUR used in practice. […] Continuous antibiotic prophylaxis (CAP) for VUR was initially studied in the 1970s and further investigated in the 1980s. […] Concern is growing among medical practitioners about the long-term use of CAP in VUR patients. […] Continuous antibiotic prophylaxis for the prevention of UTI in patients with VUR has become common practice. […] The AUA guideline on the management of primary vesicoureteral reflux in children was updated and released in September 2010. […] For children younger than 1 year with any grade of VUR and a history of febrile UTI, CAP is recommended due to the greater morbidity risk in this population. […] Since the release of the 2010 AUA guideline, Finnell et al. have published a meta-analysis on the use of CAP to prevent recurrent UTI in children with VUR.

• #5

  https://link.springer.com/article/10.1007/s40746-016-0045-9

  The past 30 years have seen broad changes in the diagnosis and management of vesicoureteral reflux (VUR). […] Given the costs and morbidity of UTI as well as the potential for significant renal injury, our approach remains conservative. […] Additionally, though we recognize the limitation of continuous antibiotic prophylaxis (CAP), we believe that the benefits outweigh the risks and costs for many patients. […] 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. […] Both studies indicate a role for CAP, especially in young girls, in preventing UTI occurrence. […] 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.

• #6 Pediatric Vesicoureteral Reflux Medication: Antibiotics

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

  These are used for maintenance of sterile urine. Antibiotic agents used for prophylaxis in children with vesicoureteral reflux (VUR) are chosen for their efficacy in the urinary tract, safety, and tolerability. The typical dose is one fourth of the therapeutic dose. They are usually administered as suspensions once daily, typically in the evening to maximize overnight drug levels in the bladder. […] The cephalosporins are used less often. […] The maturing hepatobiliary system is able to process trimethoprim-sulfamethoxazole combination agents, which have an excellent urinary concentration profile and tend to cause fewer fecal resistance problems. […] Another common urinary antiseptic agent for children 8 wk. Unpleasant taste of the liquid form makes it unacceptable to some children. Older children who can tolerate tablets do well with this medication.

• #7 Pediatric Urinary Tract Infection and Reflux | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0315/p1472.html

  Urinary tract infections in children are sometimes associated with vesicoureteral reflux, which can lead to renal scarring if it remains unrecognized. […] Documented reflux is initially treated with prophylactic antibiotics. […] Since antibiotic prophylaxis can prevent recurrent urinary tract infections, it seems prudent to screen children with urinary tract infections who are at risk for renal scarring, such as children with recurrent urinary tract infections. […] The prevention of urinary tract infections in children with reflux is essential, and the mainstay of medical management is antibiotic prophylaxis. […] The most frequently used agents are nitrofurantoin, in a dosage of 1 to 2 mg per kg once daily, and trimethoprim/sulfamethoxazole, in a dosage of 2 to 4 mg trimethoprim per kg once daily.

• #8 Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4137319/

  Children with febrile urinary tract infection commonly have vesicoureteral reflux. Because trial results have been limited and inconsistent, the use of antimicrobial prophylaxis to prevent recurrences in children with reflux remains controversial. […] Among children with vesicoureteral reflux after urinary tract infection, antimicrobial prophylaxis was associated with a substantially reduced risk of recurrence but not of renal scarring. […] Antimicrobial prophylaxis in children with vesicoureteral reflux diagnosed after a first or second urinary tract infection was associated with a halving of the risk of febrile or symptomatic recurrences. Differences between the prophylaxis and placebo groups were apparent early on and increased over a 2-year period. […] Children with bladder and bowel dysfunction at baseline and children whose index infection was febrile derived particular benefit from prophylaxis, with reductions in recurrences of approximately 80% and 60%, respectively. […] Our finding that antimicrobial prophylaxis was associated with a reduced risk of recurrence may warrant reconsideration of that recommendation.

• #9 Antimicrobial prophylaxis for vesicoureteral reflux—where will the RIVUR study lead us? | Nature Reviews Urology

  https://www.nature.com/articles/nrurol.2014.112

  Vesicoureteral reflux (VUR) affects about 30% of children presenting with a febrile UTI and has been associated with complications such as recurrent infection and renal scarring. […] Although, in some studies, antimicrobial prophylaxis has been associated with similar recurrence rates to antireflux surgery, other studies have suggested little advantage to using this approach. […] Of 607 children with VUR diagnosed after a first or second febrile or symptomatic UTI, prophylaxis with trimethoprim-sulfamethoxazole (’sulfatrim’) was associated with a substantially reduced risk of febrile or symptomatic recurrence compared with a placebo that was identical in colour, taste, smell, and consistency (12.9% versus 23.6%). […] Patients with bladder and bowel dysfunction at baseline, and those whose index infection was febrile, derived particular benefit from prophylaxis, with reductions in recurrence rates of approximately 80% and 60%, respectively.

• #10 SPU – Association Of Antibiotic Prophylaxis With Risk Of Hospitalization For Urinary Tract Infections In Children With Vesicoureteral Reflux.

  https://fallcongress.spuonline.org/program/2024/45.cgi

  While the use of continuous antibiotic prophylaxis (CAP) has been shown to prevent febrile urinary tract infections (fUTI) in children with vesicoureteral reflux (VUR), not enough is known about its effect on UTI associated morbidity. […] CAP was associated with a 38% relative risk reduction in hospitalization rate for fUTI (53.1% vs 33.1%, p=0.03, 95% CI [-0.38,-0.02]). […] This study suggests that the use of CAP offers a significant risk reduction in hospitalization for fUTIs in children with VUR.

• #11 Do antibiotics treat VUR? – Deflux

  https://deflux.com/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 odds of UTI development in children with reflux; however, evidence is conflicting with regard to CAP and prevention of renal scarring. […] 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. […] Continuous antibiotic prophylaxis did not prevent the recurrence of infection or the development of renal scars. […] Deflux offers immediate protection from further renal damage without the need for adherence to a long-term treatment regiment.

• #12 Vesicoureteral Reflux Guidelines: Guidelines Summary

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

  Guidelines on management of vesicoureteral reflux (VUR) have been published by the following organizations: American Urological Association(AUA) [10] […] European Association of Urology (EAU) [5]. […] Recommendations for antibiotic prophylaxis vary according to age at diagnosis. For initial management of VUR in children 1 year, recommendations are as follows [10]: Continuous antibiotic prophylaxis (CAP), if child has a history of a febrile urinary tract infection (UTI) […] Offer CAP for VUR grades IIIV, if child has no history of febrile UTI […] Consider CAP for VUR grades I-II, if child has no history of febrile UTI. […] CAP for the child with bladder/bowel dysfunction and VUR due to the increased risk of UTI while bladder/bowel dysfunction (BBD) is present and being treated […] CAP may be considered for the child with a history of UTIs in the absence of BBD […] Observational management without CAP, with prompt initiation of antibiotic therapy for UTIs, may be considered for the child with VUR in the absence of bladder/bowel dysfunction, recurrent febrile UTIs, or renal cortical abnormalities […] Surgical intervention for VUR, including both open and endoscopic methods, may be used.

• #13 Vesicoureteral Reflux Topics – American Urological Association

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

  Topic 1 Management of vesicoureteral reflux in the child over one year of age […] The association between VUR and febrile UTI was established in the 1997 AUA Guideline for Pediatric Vesicoureteral Reflux based upon a significantly higher incidence of febrile UTI in children with ongoing VUR than in those with resolved or surgically treated VUR. Identification and management of VUR provides the potential opportunity to prevent renal damage. […] In order to reduce the morbidity of acute pyelonephritis and the risk of permanent renal injury, treatment of VUR is recommended. Treatment options include observation, continuous antibiotic prophylaxis (CAP), and interventions of curative intent. […] Continuous Antibiotic Prophylaxis in the Treatment of VUR […] Current standard therapy for VUR includes the use of CAP to prevent acute infection with the anticipation that spontaneous resolution of VUR will occur in a significant proportion of children. […] Although the incidence of cystitis and nonspecified UTIs was similar between those receiving or not receiving CAP, the incidence of febrile UTIs in children receiving CAP was greater than those not receiving CAP.

• #14 Vesicoureteral Reflux Topics – American Urological Association

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

  Topic 1 Management of vesicoureteral reflux in the child over one year of age […] The association between VUR and febrile UTI was established in the 1997 AUA Guideline for Pediatric Vesicoureteral Reflux based upon a significantly higher incidence of febrile UTI in children with ongoing VUR than in those with resolved or surgically treated VUR. Identification and management of VUR provides the potential opportunity to prevent renal damage. […] In order to reduce the morbidity of acute pyelonephritis and the risk of permanent renal injury, treatment of VUR is recommended. Treatment options include observation, continuous antibiotic prophylaxis (CAP), and interventions of curative intent. […] Continuous Antibiotic Prophylaxis in the Treatment of VUR […] Current standard therapy for VUR includes the use of CAP to prevent acute infection with the anticipation that spontaneous resolution of VUR will occur in a significant proportion of children. […] Although the incidence of cystitis and nonspecified UTIs was similar between those receiving or not receiving CAP, the incidence of febrile UTIs in children receiving CAP was greater than those not receiving CAP.

• #15 Vesicoureteral Reflux Guidelines: Guidelines Summary

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

  Guidelines on management of vesicoureteral reflux (VUR) have been published by the following organizations: American Urological Association(AUA) [10] […] European Association of Urology (EAU) [5]. […] Recommendations for antibiotic prophylaxis vary according to age at diagnosis. For initial management of VUR in children 1 year, recommendations are as follows [10]: Continuous antibiotic prophylaxis (CAP), if child has a history of a febrile urinary tract infection (UTI) […] Offer CAP for VUR grades IIIV, if child has no history of febrile UTI […] Consider CAP for VUR grades I-II, if child has no history of febrile UTI. […] CAP for the child with bladder/bowel dysfunction and VUR due to the increased risk of UTI while bladder/bowel dysfunction (BBD) is present and being treated […] CAP may be considered for the child with a history of UTIs in the absence of BBD […] Observational management without CAP, with prompt initiation of antibiotic therapy for UTIs, may be considered for the child with VUR in the absence of bladder/bowel dysfunction, recurrent febrile UTIs, or renal cortical abnormalities […] Surgical intervention for VUR, including both open and endoscopic methods, may be used.

• #16 Vesicoureteral Reflux Guidelines: Guidelines Summary

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

  The EAU guidelines provide recommendations on conservative and surgical therapy for VUR. Conservative therapy has the objective of preventing febrile UTI, and comprises the following: Watchful waiting […] Intermittent or continuous antibiotic prophylaxis […] Bladder rehabilitation in patients with LUTD […] Consideration of circumcision during early infancy […] Regular follow-up with imaging studies (eg, VCUG, nuclear cystography, or DMSA scan). […] Initially treat all patients diagnosed within the first year of life with CAP, regardless of the grade of reflux or presence of renal scars […] Offer immediate, parenteral antibiotic treatment for febrile breakthrough infections […] Offer definitive surgical or endoscopic correction to patients with frequent breakthrough infections […] Offer open surgical correction to patients with persistent high-grade reflux and endoscopic correction for lower grades of reflux […] Offer close surveillance without antibiotic prophylaxis to children presenting with lower grades of reflux and without symptoms.

• #17 Vesicoureteral Reflux Guidelines: Guidelines Summary

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

  The EAU guidelines provide recommendations on conservative and surgical therapy for VUR. Conservative therapy has the objective of preventing febrile UTI, and comprises the following: Watchful waiting […] Intermittent or continuous antibiotic prophylaxis […] Bladder rehabilitation in patients with LUTD […] Consideration of circumcision during early infancy […] Regular follow-up with imaging studies (eg, VCUG, nuclear cystography, or DMSA scan). […] Initially treat all patients diagnosed within the first year of life with CAP, regardless of the grade of reflux or presence of renal scars […] Offer immediate, parenteral antibiotic treatment for febrile breakthrough infections […] Offer definitive surgical or endoscopic correction to patients with frequent breakthrough infections […] Offer open surgical correction to patients with persistent high-grade reflux and endoscopic correction for lower grades of reflux […] Offer close surveillance without antibiotic prophylaxis to children presenting with lower grades of reflux and without symptoms.

• #18 Pediatric Vesicoureteral Reflux Medication: Antibiotics

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

  These are used for maintenance of sterile urine. Antibiotic agents used for prophylaxis in children with vesicoureteral reflux (VUR) are chosen for their efficacy in the urinary tract, safety, and tolerability. The typical dose is one fourth of the therapeutic dose. They are usually administered as suspensions once daily, typically in the evening to maximize overnight drug levels in the bladder. […] The cephalosporins are used less often. […] The maturing hepatobiliary system is able to process trimethoprim-sulfamethoxazole combination agents, which have an excellent urinary concentration profile and tend to cause fewer fecal resistance problems. […] Another common urinary antiseptic agent for children 8 wk. Unpleasant taste of the liquid form makes it unacceptable to some children. Older children who can tolerate tablets do well with this medication.

• #19 Pediatric Urinary Tract Infection and Reflux | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0315/p1472.html

  Urinary tract infections in children are sometimes associated with vesicoureteral reflux, which can lead to renal scarring if it remains unrecognized. […] Documented reflux is initially treated with prophylactic antibiotics. […] Since antibiotic prophylaxis can prevent recurrent urinary tract infections, it seems prudent to screen children with urinary tract infections who are at risk for renal scarring, such as children with recurrent urinary tract infections. […] The prevention of urinary tract infections in children with reflux is essential, and the mainstay of medical management is antibiotic prophylaxis. […] The most frequently used agents are nitrofurantoin, in a dosage of 1 to 2 mg per kg once daily, and trimethoprim/sulfamethoxazole, in a dosage of 2 to 4 mg trimethoprim per kg once daily.

• #20 Pediatric Vesicoureteral Reflux Medication: Antibiotics

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

  These are used for maintenance of sterile urine. Antibiotic agents used for prophylaxis in children with vesicoureteral reflux (VUR) are chosen for their efficacy in the urinary tract, safety, and tolerability. The typical dose is one fourth of the therapeutic dose. They are usually administered as suspensions once daily, typically in the evening to maximize overnight drug levels in the bladder. […] The cephalosporins are used less often. […] The maturing hepatobiliary system is able to process trimethoprim-sulfamethoxazole combination agents, which have an excellent urinary concentration profile and tend to cause fewer fecal resistance problems. […] Another common urinary antiseptic agent for children 8 wk. Unpleasant taste of the liquid form makes it unacceptable to some children. Older children who can tolerate tablets do well with this medication.

• #21 Endoscopic Management of Complicated Highgrade Vesicoureteral Reflux in the First Year of Life – The Journal of Pediatric Research

  https://jpedres.org/articles/endoscopic-management-of-complicated-highgrade-vesicoureteral-reflux-in-the-first-year-of-life/doi/jpr.galenos.2021.37132

  The treatment of vesicoureteral reflux (VUR) in infants is controversial. Subureteric injection is considered by some to be a popular alternative to long-term antibiotic prophylaxis. […] The management of high-grade infantile reflux is still controversial with insufficient data. Published studies comparing endoscopic treatment and antibiotic prophylaxis have inconclusive results due to their wide range of success rates. Although it needs to be supported by prospective studies, endoscopic treatment is a successful alternative in high-grade VUR infants with breakthrough infection. […] Continuous antibiotic prophylaxis (CAP) was started with amoxicillin for babies under three months of age, and with co-trimoxazole after this period. […] Several studies draw attention to a higher risk of recurrent and complicated UTI with resistant microorganisms under prophylaxis.

• #22 Pediatric Urinary Tract Infection and Reflux | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0315/p1472.html

  Urinary tract infections in children are sometimes associated with vesicoureteral reflux, which can lead to renal scarring if it remains unrecognized. […] Documented reflux is initially treated with prophylactic antibiotics. […] Since antibiotic prophylaxis can prevent recurrent urinary tract infections, it seems prudent to screen children with urinary tract infections who are at risk for renal scarring, such as children with recurrent urinary tract infections. […] The prevention of urinary tract infections in children with reflux is essential, and the mainstay of medical management is antibiotic prophylaxis. […] The most frequently used agents are nitrofurantoin, in a dosage of 1 to 2 mg per kg once daily, and trimethoprim/sulfamethoxazole, in a dosage of 2 to 4 mg trimethoprim per kg once daily.

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

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

  Vesicoureteral reflux (VUR) is most often due to congenital anomalous development of the ureterovesical junction. […] Mild to moderate vesicoureteral reflux often resolves spontaneously over months to several years. It is very important to keep children free of infection. […] 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. […] Symptomatic reflux (recurrent infections, impaired renal growth, renal scarring, or bladder dysfunction) is treated with endoscopic injection of a bulking agent (eg, dextranomer/hyaluronic acid) or ureteral reimplantation. […] Children with newly diagnosed VUR are given prophylactic antibiotics depending on the severity and clinical course.

• #24 Antibiotic prophylaxis in vesicoureteral reflux

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3676196/

  Antibiotic prophylaxis for the prevention of UTIs and watchful waiting are currently the most common treatments for VUR used in practice. […] Continuous antibiotic prophylaxis (CAP) for VUR was initially studied in the 1970s and further investigated in the 1980s. […] Concern is growing among medical practitioners about the long-term use of CAP in VUR patients. […] Continuous antibiotic prophylaxis for the prevention of UTI in patients with VUR has become common practice. […] The AUA guideline on the management of primary vesicoureteral reflux in children was updated and released in September 2010. […] For children younger than 1 year with any grade of VUR and a history of febrile UTI, CAP is recommended due to the greater morbidity risk in this population. […] Since the release of the 2010 AUA guideline, Finnell et al. have published a meta-analysis on the use of CAP to prevent recurrent UTI in children with VUR.

• #25 Outcomes in children with vesicoureteral reflux receiving antibiotic prophylaxis | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/outcomes-in-children-with-vesicoureteral-reflux-receiving-antibiotic-prophylaxis/EDFE9BE3FB8DE492D4CAEC2E731740A2

  Antibiotic prophylaxis in children with vesicoureteral reflux (VUR) remains controversial. […] Daily antibiotic prophylaxis has been utilized in children with VUR, in an effort to reduce UTI recurrence, but remains variable by institution and among providers. […] The American Academy of Pediatrics (AAP) has reemphasized with recent guideline iterations, the growing body of evidence suggesting a lack of benefit from daily antibiotic prophylaxis and global concerns with antibiotic resistance. […] Our study aimed to provide additional data for this practice by determining incidence of UTI recurrence in children receiving antibiotic prophylaxis for VUR, including those with urologic anomalies. […] The major findings of this study are that 33% of patients without urologic anomalies receiving antibiotic prophylaxis had recurrence of UTIs and 33% of organisms cultured at the time of first recurrence were resistant to the initial prophylactic antibiotic.

• #26 Outcomes in children with vesicoureteral reflux receiving antibiotic prophylaxis | Antimicrobial Stewardship & Healthcare Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/outcomes-in-children-with-vesicoureteral-reflux-receiving-antibiotic-prophylaxis/EDFE9BE3FB8DE492D4CAEC2E731740A2

  Given the conflicting evidence available, some investigators have attempted to identify risk factors for UTI recurrence, in which benefits may outweigh the risks of antibiotic prophylaxis. […] Our description of a subset of patients with urologic anomalies receiving antibiotic prophylaxis also showed a high rate of UTI recurrence, highlighting the risk of antibiotic prophylaxis in a group of patients who may benefit from a procedural intervention for secondary VUR. […] Overall resistance trends found in this study, including 25% of children infected with a multidrug-resistant organism, brings to question opportunities to modify risk factors for antimicrobial resistance and identify risk factors which necessitate continued antimicrobial use, especially given the RIVUR trial found even higher rates of resistance to the prophylactic antibiotic.

• #27 Risks of Prophylaxis to Prevent Recurrent UTIs in Children with Vesicoureteral Refluxlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na47149/2018/07/17/risks-prophylaxis-prevent-recurrent-utis-children-with

  A meta-analysis reveals that antibiotic prophylaxis reduces the risk of recurrent urinary tract infection but increases the risk that a recurrent UTI will be multidrug resistant. […] Children with vesicoureteral reflux (VUR) are often given oral antibiotic prophylaxis to prevent recurrent urinary tract infections (UTIs). […] The analysis revealed that treating 21 children with VUR with prophylaxis would prevent 1 UTI. However, treating 21 children with prophylaxis would also result in 1 child with a multidrug-resistant recurrent UTI. […] Remarkably, the probability of preventing a recurrent UTI with prophylaxis is equal to the risk of developing a multidrug-resistant UTI while on prophylaxis.

• #28 Periureteral Bulking Agents for the Treatment of Vesicoureteral Reflux (VUR)

  https://www.southcarolinablues.com/web/public/brands/medicalpolicy/external-policies/periureteral-bulking-agents-for-the-treatment-of-vesicoureteral-reflux-vur/

  Most commonly seen in children, vesicoureteral reflux (VUR) is the retrograde flow of urine from the bladder upward toward the kidney. The primary management strategies have been prophylactic antibiotics to reduce urinary tract infections and, for higher grade disease, surgical correction of the underlying reflux. […] The decision to administer prophylactic antibiotic treatment includes consideration of potential adverse events of long-term antibiotic treatment, which can include allergic reactions and development of treatment-resistant bacteria resulting in breakthrough UTIs. […] At present, in the absence of definitive answers on the utility of treating VUR or the best treatment option, antibiotic prophylaxis to prevent recurrent UTIs and surgery to treat the underlying reflux remain accepted management strategies.

• #29 Pediatric Vesicoureteral Reflux Medication: Antibiotics

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

  Risk factors for breakthrough urinary tract infection in children with vesicoureteral reflux receiving continuous antibiotic prophylaxis. […] Impact of continuous low-dose antibiotic prophylaxis on growth in children with vesicoureteral reflux. […] Weight Gain and Obesity in Infants and Young Children Exposed to Prolonged Antibiotic Prophylaxis.

• #30 Do antibiotics treat VUR? – Deflux

  https://deflux.com/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 odds of UTI development in children with reflux; however, evidence is conflicting with regard to CAP and prevention of renal scarring. […] 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. […] Continuous antibiotic prophylaxis did not prevent the recurrence of infection or the development of renal scars. […] Deflux offers immediate protection from further renal damage without the need for adherence to a long-term treatment regiment.

• #31 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. […] The elimination of bladder and bowel dysfunction [BBD] is an important management strategy to prevent further FUTIs, regardless of treatment choice. […] Antibiotic prophylaxis is a safe and effective modality to sterilize the urinary tract. […] The latest AUA VUR guidelines recognize this concomitant relationship between VUR, UTIs, and BBD. […] Due to this comorbidity, the AUA recommends screening for symptoms indicative of BBD upon initial evaluation. […] The guidelines recommend treatment of BBD prior to any surgical treatment of VUR. […] Lastly, continuous antibiotic prophylaxis [CAP] is recommended for those with concomitant BBD and VUR due to an increased risk of UTI.

• #32

  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.

• #33

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

  Although the majority of VUR cases can be successfully treated conservatively, treatment protocols as well as several conflicting results on the effectiveness of the said modalities should be clarified. […] 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. […] Bladder training is an important part of the BBD treatment. […] Therefore, considering the high risk of UTI in patients with VUR, especially with BBD, bladder training should be offered for all patients with VUR. […] Continuous antibiotic prophylaxis (CAP) has been used to prevent febrile UTIs, its effect on renal scarring, and prevent UTI recurrences. […] CAP is among the most successful yet controversial conservative treatment available for patients with VUR.

• #34 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Vesicoureteral-Reflux-Management-and-Treatment.aspx

  In general, the primary goal of treating children with VUR is to prevent renal complications and infection. […] Antibiotic prophylaxis is generally safe and it may or may not be used in children who are expected to experience spontaneous resolution. […] For some time now, the efficacy of antibiotic prophylaxis has been an area under heavy dispute by various studies. […] Nonetheless, the role of antibiotics in the setting of acute infection is not debatable, as failure to use these agents will cause worsening of the infection with serious consequences to the kidney(s). […] In the setting of secondary VUR and dysfunctional micturition (i.e. urination), anticholinergic agents are another group of drugs that may be beneficial. […] When they are used together with timed urination, these drugs may control the symptoms associated with the dysfunction and, in addition to this, reduce the risk of infection that accompanies VUR.

• #35

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

  Although the majority of VUR cases can be successfully treated conservatively, treatment protocols as well as several conflicting results on the effectiveness of the said modalities should be clarified. […] 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. […] Bladder training is an important part of the BBD treatment. […] Therefore, considering the high risk of UTI in patients with VUR, especially with BBD, bladder training should be offered for all patients with VUR. […] Continuous antibiotic prophylaxis (CAP) has been used to prevent febrile UTIs, its effect on renal scarring, and prevent UTI recurrences. […] CAP is among the most successful yet controversial conservative treatment available for patients with VUR.

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

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

  Can VUR be prevented? […] There isnt a known way to prevent vesicoureteral reflux (VUR) not with food, lifestyle changes or medication. But there are steps you can take to improve your childs overall urinary tract health. Make sure your child: […] Drinks enough water. […] Gets their diaper changed immediately after they poop and pee. […] Pees regularly and avoids holding it. […] Receives treatment for constipation and urinary or fecal incontinence as soon as possible. […] Help your child to be healthy by encouraging exercise and making sure meals are balanced and nutritious.

• #37

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

  Although the use of probiotics for the prevention of UTIs in patients with VUR has not been widely recommended, several studies have shown the positive effect of probiotics on the risk of UTIs in VUR. […] Circumcision can be one of the additional conservative therapy options for VUR in male patients, especially in under 1-year-old pediatric patients. […] Thus, circumcision can be considered in all male patients with VUR if possible. […] Based on available guidelines and our review, the treatment of VUR should be stratified based on the grade, age, and history of breakthrough UTI. […] Conservative treatment involving bladder training, anticholinergics, circumcision, or probiotics may be considered in patients aged 1-5 years old. […] The current literature supports active monitoring aided by several therapeutic modalities, including BBD management through bladder training accompanied by anticholinergic and alpha-blockers, CAP, prophylaxis with probiotics, and circumcision in male patients.

• #38 The Pee Saga: Our Life with Vesicoureteral Reflux – Complex Child

  https://complexchild.org/articles/2014-articles/october/pee-saga/

  Understand the downsides of prophylaxis and request a nutrition referral through either your pediatrician or Early Intervention. Nutritionists can help offset some of the GI and growth issues that accompany VUR prophylaxis treatment. Discuss the use of a probiotic to help ease GI issues associated with long-term antibiotic use. […] With smart, proactive treatment, you can help minimize the chance of kidney scarring, and offset some of the negative aspects of a VUR diagnosis.

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

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

  Can VUR be prevented? […] There isnt a known way to prevent vesicoureteral reflux (VUR) not with food, lifestyle changes or medication. But there are steps you can take to improve your childs overall urinary tract health. Make sure your child: […] Drinks enough water. […] Gets their diaper changed immediately after they poop and pee. […] Pees regularly and avoids holding it. […] Receives treatment for constipation and urinary or fecal incontinence as soon as possible. […] Help your child to be healthy by encouraging exercise and making sure meals are balanced and nutritious.

• #40 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. […] The goal is to prevent UTIs and kidney damage while the reflux is improving. […] 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. […] We encourage your child to empty her bladder every two to three hours, without holding. […] All of these steps can help reduce the risk of bacteria growing in your child’s urine. […] 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.

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

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

  VUR is diagnosed by a test called a voiding cysto-urethrogram (VCUG). A VCUG is usually done if: […] 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. […] 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). […] Continue to help your child with healthy bladder and bowel habits. All potty-trained children with VUR need to work on this to help prevent UTIs. […] It is also important that children completely empty their bladder every 2-3 hours when they are awake. Children should avoid holding their urine for long periods. This helps keep the bladder clean and prevents UTIs. […] Many children grow out of VUR over time, often by age 5. Finding VUR early and monitoring it closely with your child’s doctors–and getting treatment if needed–will help avoid any lasting problems.

• #42 Kidney infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/kidney-infection/symptoms-causes/syc-20353387

  Bacteria that enter the urinary tract through the urethra can multiply and travel to your kidneys. This is the most common cause of kidney infections. […] Having a condition that causes urine to flow the wrong way. In vesicoureteral reflux, small amounts of urine flow from the bladder back into the tubes that connect the bladder and kidneys. People with this condition are at higher risk of kidney infections when they’re kids and when they become adults. […] Reduce your risk of kidney infection by taking steps to prevent urinary tract infections. Women in particular may lower the risk of urinary tract infections if they: […] Drink fluids, especially water. Fluids can help remove bacteria from the body when you urinate. […] Urinate as soon as you need to. Don’t delay urinating when you feel the urge.

• #43 Kidney infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/kidney-infection/symptoms-causes/syc-20353387

  Empty the bladder after sexual intercourse. Urinating as soon as possible after sex helps clear bacteria from the urethra. This lowers the risk of infection. […] Wipe carefully. Wipe from front to back after urinating and after a bowel movement. This helps prevent bacteria from spreading to the urethra. […] Avoid using products in the genital area. Deodorant sprays in the genital area or douches can be irritating.

• #44

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

  Although the use of probiotics for the prevention of UTIs in patients with VUR has not been widely recommended, several studies have shown the positive effect of probiotics on the risk of UTIs in VUR. […] Circumcision can be one of the additional conservative therapy options for VUR in male patients, especially in under 1-year-old pediatric patients. […] Thus, circumcision can be considered in all male patients with VUR if possible. […] Based on available guidelines and our review, the treatment of VUR should be stratified based on the grade, age, and history of breakthrough UTI. […] Conservative treatment involving bladder training, anticholinergics, circumcision, or probiotics may be considered in patients aged 1-5 years old. […] The current literature supports active monitoring aided by several therapeutic modalities, including BBD management through bladder training accompanied by anticholinergic and alpha-blockers, CAP, prophylaxis with probiotics, and circumcision in male patients.

• #45 Vesicoureteral Reflux Guidelines: Guidelines Summary

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

  The EAU guidelines provide recommendations on conservative and surgical therapy for VUR. Conservative therapy has the objective of preventing febrile UTI, and comprises the following: Watchful waiting […] Intermittent or continuous antibiotic prophylaxis […] Bladder rehabilitation in patients with LUTD […] Consideration of circumcision during early infancy […] Regular follow-up with imaging studies (eg, VCUG, nuclear cystography, or DMSA scan). […] Initially treat all patients diagnosed within the first year of life with CAP, regardless of the grade of reflux or presence of renal scars […] Offer immediate, parenteral antibiotic treatment for febrile breakthrough infections […] Offer definitive surgical or endoscopic correction to patients with frequent breakthrough infections […] Offer open surgical correction to patients with persistent high-grade reflux and endoscopic correction for lower grades of reflux […] Offer close surveillance without antibiotic prophylaxis to children presenting with lower grades of reflux and without symptoms.

• #46 Vesicoureteral reflux – Wikipedia

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

  A surgical approach is necessary in cases where a breakthrough infection results despite prophylaxis, or there is non-compliance with the prophylaxis. […] The American Urological Association recommends ongoing monitoring of children with VUR until the abnormality resolves or is no longer clinically significant.

• #47 Vesicoureteral Reflux – Children’s Hospital of Orange County

  https://choc.org/programs-services/urology/vesicoureteral-reflux/

  Many cases of reflux, especially those with a lower grade, can resolve over time, usually within five years. […] Most children will be recommended to start on prophylactic antibiotics until they are toilet trained to help keep their urine sterile and free of bacteria. This treatment option allows us to protect the child from urinary tract infections while waiting for the VUR to go away by itself. […] When children are toilet trained we work with the child and family to ensure that they are practicing the best behavioral modifications to reduce their chances of developing infections. […] If a child persists with recurrent febrile UTIs (when not on prophylaxis) or breakthrough infections then they may require a surgical intervention to resolve their reflux. […] The common procedure completed is a cystoscopy and Deflux injection.

• #48 Pediatric Urinary Tract Infection and Reflux | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0315/p1472.html

  Any patient under observation who develops a breakthrough urinary tract infection or new renal scarring should undergo surgical correction of reflux. […] The standard operation for vesicoureteral reflux is ureteral reimplantation, which is successful in 95 percent of cases. […] The subtrigonal injection of collagen is a relatively new alternative treatment for vesicoureteral reflux.

• #49 Vesicoureteral Reflux – Children’s Hospital of Orange County

  https://choc.org/programs-services/urology/vesicoureteral-reflux/

  Some children will not be good candidates for Deflux or the Deflux may fail. If this occurs a ureteral reimplant surgery can be completed at our facility. This surgery involves removing the ureter where it joins the bladder and reimplanting it at another spot on the bladder. It is about 99% effective in resolving reflux.

• #50 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. […] 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. […] Endoscopic injection involves applying a gel around the ureteral opening to create a valve function and stop urine from flowing back up the ureter. […] Medical treatment entails low dose antibiotic prophylaxis until resolution of VUR occurs. Antibiotics are administered nightly at half the normal therapeutic dose.

• #51 Vesicoureteral Reflux – Children’s Hospital of Orange County

  https://choc.org/programs-services/urology/vesicoureteral-reflux/

  Many cases of reflux, especially those with a lower grade, can resolve over time, usually within five years. […] Most children will be recommended to start on prophylactic antibiotics until they are toilet trained to help keep their urine sterile and free of bacteria. This treatment option allows us to protect the child from urinary tract infections while waiting for the VUR to go away by itself. […] When children are toilet trained we work with the child and family to ensure that they are practicing the best behavioral modifications to reduce their chances of developing infections. […] If a child persists with recurrent febrile UTIs (when not on prophylaxis) or breakthrough infections then they may require a surgical intervention to resolve their reflux. […] The common procedure completed is a cystoscopy and Deflux injection.

• #52 Predicting the best treatment for vesicoureteral reflux in kids: The power of machine learning – Boston Children’s Answers

  https://answers.childrenshospital.org/machine-learning-antibiotics/

  Giving continuous antibiotic prophylaxis to 40 percent of patients with VUR — instead of giving them to all VUR patients — could result in minimal recurrent UTIs. […] Previous research has shown that when taken continuously, prophylactic antibiotics can reduce the risk of recurrent UTI in about half of this population. […] The model’s ability to predict recurrent UTIs was strong, with an “area under curve” of 0.82. Wang and his colleagues found that giving continuous antibiotic prophylaxis to 40 percent of patients with VUR — instead of giving them to all VUR patients — could result in minimal recurrent UTIs. […] This machine learning model could allow physicians to identify the patients who would benefit most from antibiotic prophylaxis, so those who don’t need it will be spared any adverse drug effects. Such a tool could also achieve optimal outcomes while minimizing unnecessary treatments and saving costs.

• #53 Machine learning-based prediction of vesicoureteral reflux outcomes in infants under antibiotic prophylaxis | Scientific Reports

  https://www.nature.com/articles/s41598-025-92847-3

  We aimed to investigate the independent outcome predictors of continuous antibiotic prophylaxis (CAP) in vesicoureteral reflux, train a model to predict the outcome, and evaluate which infants should be referred for endoscopic vesicoureteral reflux correction in their first visits. […] In conclusion, renal scarring and bladder dysfunction were predictors of vesicoureteral reflux outcomes when the infant was receiving CAP. Therefore, referring these patients to a urologist is advised during their first visits as they benefit from endoscopic injection. […] The optimal method for treating VUR in infants is controversial, and the best selection method to treat the patients with CAP or to refer them to a urologist for surgical intervention is lacking. […] We therefore suggest referring patients with renal scarring and/or bladder dysfunction to a urologist for surgical intervention at first visits by pediatricians/nephrologists.

• #54

  https://link.springer.com/article/10.1007/s00467-010-1632-9

  The role of antimicrobial prophylaxis in vesicoureteral reflux (VUR) has come under increasing scrutiny because of better analytical methods in the published literature, knowledge gained from VUR and renal scars diagnosed without preceding urinary tract infection (UTI), and better renal imaging modalities for diagnosing renal scars. […] More research is needed to validate the role of prophylaxis in VUR diagnosed after UTI, and even more research is warranted to answer the questions regarding antimicrobial prophylaxis across the spectrum of VUR in different clinical settings. […] A decision regarding the use of prophylaxis in a particular patient with VUR depends on multiple factors that include the type of VUR, its severity, age at diagnosis, history of preceding UTI, coexisting voiding dysfunction and/or constipation, and severity of renal scarring.

• #55

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

  Although the use of probiotics for the prevention of UTIs in patients with VUR has not been widely recommended, several studies have shown the positive effect of probiotics on the risk of UTIs in VUR. […] Circumcision can be one of the additional conservative therapy options for VUR in male patients, especially in under 1-year-old pediatric patients. […] Thus, circumcision can be considered in all male patients with VUR if possible. […] Based on available guidelines and our review, the treatment of VUR should be stratified based on the grade, age, and history of breakthrough UTI. […] Conservative treatment involving bladder training, anticholinergics, circumcision, or probiotics may be considered in patients aged 1-5 years old. […] The current literature supports active monitoring aided by several therapeutic modalities, including BBD management through bladder training accompanied by anticholinergic and alpha-blockers, CAP, prophylaxis with probiotics, and circumcision in male patients.

• #56 Risk factors for breakthrough urinary tract infection in children with vesicoureteral reflux receiving continuous antibiotic prophylaxis – Su – Translational Pediatrics

  https://tp.amegroups.org/article/view/87366/html

  To investigate the risk factors for breakthrough urinary tract infection (BT-UTI) in children with vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). […] The current treatment strategies were designed to reduce new renal injury and prevent new UTIs. […] The guidelines developed by the American Urological Association and European Association of Urology still recommend CAP as the preferred treatment for most children with VUR. CAP can minimize bacterial growth and avoid breakthrough urinary tract infection (BT-UTI) as much as possible, thereby reducing the renal scarring. […] A meta-analysis on the role of CAP in children with VUR showed that CAP was effective in preventing the recurrence of BT-UTI. […] For VUR children receiving CAP, younger age at the initial diagnosis of UTI (12 months), bilateral VUR, and BBD were independent risk factors for the occurrence of BT-UTI.

• #57 Risk factors for breakthrough urinary tract infection in children with vesicoureteral reflux receiving continuous antibiotic prophylaxis – Su – Translational Pediatrics

  https://tp.amegroups.org/article/view/87366/html

  Despite receiving CAP and regular follow-up, some children with VUR still experienced BT-UTI. […] The incidence of BT-UTI was 31.64%, and the incidence of more than one bout of BT-UTI was 14.11%. […] In this study, the HR of BT-UTI in VUR children younger than 12 months vs. VUR children older than 12 months was 4.6. […] This study found that younger age at the initial diagnosis of UTI (12 months), bilateral VUR and BBD were risk factors for BT-UTI recurrence. All of these factors need attention in clinical diagnosis and treatment.

• #58 Vesicoureteral Reflux Topics – American Urological Association

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

  Recommendation: Continuous antibiotic prophylaxis may be considered for the child with a history of urinary tract infection and VUR in the absence of bladder/bowel dysfunction. […] Follow-up Management of the Child with VUR […] General evaluation, including monitoring of blood pressure, height, and weight is recommended annually. […] 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. […] Management following resolution of VUR […] Following the resolution of VUR, either spontaneously or by surgical intervention, general evaluation, including monitoring of blood pressure, height, and weight, and urinalysis for protein and urinary tract infection, is recommended annually through adolescence if either kidney is abnormal by ultrasound or DMSA scanning. […] It is recommended that the long-term concerns of hypertension (particularly during pregnancy), renal functional loss, recurrent urinary tract infection, and familial VUR in the child’s siblings and offspring be discussed with the family and communicated to the child at an appropriate age.

• #59 Vesicoureteral reflux – Wikipedia

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

  A surgical approach is necessary in cases where a breakthrough infection results despite prophylaxis, or there is non-compliance with the prophylaxis. […] The American Urological Association recommends ongoing monitoring of children with VUR until the abnormality resolves or is no longer clinically significant.

• #60 Vesicoureteral Reflux Topics – American Urological Association

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

  Recommendation: Continuous antibiotic prophylaxis may be considered for the child with a history of urinary tract infection and VUR in the absence of bladder/bowel dysfunction. […] Follow-up Management of the Child with VUR […] General evaluation, including monitoring of blood pressure, height, and weight is recommended annually. […] 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. […] Management following resolution of VUR […] Following the resolution of VUR, either spontaneously or by surgical intervention, general evaluation, including monitoring of blood pressure, height, and weight, and urinalysis for protein and urinary tract infection, is recommended annually through adolescence if either kidney is abnormal by ultrasound or DMSA scanning. […] It is recommended that the long-term concerns of hypertension (particularly during pregnancy), renal functional loss, recurrent urinary tract infection, and familial VUR in the child’s siblings and offspring be discussed with the family and communicated to the child at an appropriate age.

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

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

  VUR is diagnosed by a test called a voiding cysto-urethrogram (VCUG). A VCUG is usually done if: […] 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. […] 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). […] Continue to help your child with healthy bladder and bowel habits. All potty-trained children with VUR need to work on this to help prevent UTIs. […] It is also important that children completely empty their bladder every 2-3 hours when they are awake. Children should avoid holding their urine for long periods. This helps keep the bladder clean and prevents UTIs. […] Many children grow out of VUR over time, often by age 5. Finding VUR early and monitoring it closely with your child’s doctors–and getting treatment if needed–will help avoid any lasting problems.

• #62

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

  VUR is diagnosed by a test called a voiding cysto-urethrogram (VCUG). A VCUG is usually done if: […] 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). […] Continue to help your child with healthy bladder and bowel habits. All potty-trained children with VUR need to work on this to help prevent UTIs. […] It is also important that children completely empty their bladder every 2-3 hours when they are awake. Children should avoid holding their urine for long periods. This helps keep the bladder clean and prevents UTIs. […] Many children grow out of VUR over time, often by age 5. Finding VUR early and monitoring it closely with your child’s doctors–and getting treatment if needed–will help avoid any lasting problems.

• #63 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/

  Vesicoureteral Reflux (VUR) is characterized by a retrograde flow of urine from the bladder into the ureters and kidneys. […] Children presenting with Vesicoureteral Reflux require careful evaluation and treatment to avoid future urinary tract infections and kidney scars. […] The use of low-dose antibiotics to prevent UTI in children with VUR is based on the observation that VUR has a high spontaneous resolution rate in the first 4 to 5 years of life (80% grade III VUR, 30-50% grades III-IV). […] Continuous antibiotic prophylaxis, when instituted, should be adequate for the child’s age group and the antimicrobial susceptibility pattern of the population in the area the child lives. […] The recommendation of this panel is that CAP should be indicated in all infants and children who have not yet completed sphincter training and who present VUR grade III or higher. However, those with VUR grade I and II also appear to benefit from CAP and the decision should be made after discussing with the family.

• #64 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 management of VUR aims to prevent the onset of new episodes of UTI and loss of renal function. Clinical treatment consists of continuous administration of low-dose antibiotics to maintain sterile urine and thereby prevent pyelonephritis and formation of renal scars. […] The panels opinion is that all the above mentioned factors should be evaluated and taken into consideration when discussing with the family the therapeutic options for treating a child with VUR. This panel strongly recommends that treatment of LUTD and constipation should precede any intervention for treatment of VUR. […] This panel recommends the endoscopic treatment of VUR as the first surgical treatment option, except for Grade V VUR with significant ureteral dilatation. […] The panel also recommends that after a second unsuccessful endoscopic injection, the possibility of treatment with open surgery should be considered.

• #65 The VUR-UTI Connection: Multiple Factors at Play | Children’s Hospital of Philadelphia

  https://www.chop.edu/news/vur-uti-connection-multiple-factors-play

  Vesicoureteral reflux (VUR) remains a hot topic in the world of pediatric urology and in pediatrics in general as it is so intimately related to urinary tract infections (UTIs). […] To determine optimal management of VUR for each patient, the constellation of the above factors needs to be evaluated, as these brief cases demonstrate. […] We started her on antibiotic prophylaxis, and a VCUG demonstrated R grade 3 VUR and L grade 2. […] 2 breakthrough febrile UTIs despite antibiotic prophylaxis can be an indication for surgery. […] She was restarted on Bactrim prophylaxis, and due to a history of dysfunctional voiding and constipation, she was started on MiraLAX and began biofeedback to optimize her voiding dynamics. […] Treating reflux will not always prevent UTIs. […] Once toilet trained, as long as child remains free of dysfunctional voiding, antibiotics can be stopped.

• #66 The VUR-UTI Connection: Multiple Factors at Play | Children’s Hospital of Philadelphia

  https://www.chop.edu/news/vur-uti-connection-multiple-factors-play

  In general, if babies are diagnosed with VUR after a febrile illness, we aim to allow them time to grow out of the reflux with continuous antibiotic prophylaxis. […] If breakthrough infections persist, sometimes surgery is necessary, but even this must be followed with diligent maintenance of routine voiding and bowel habits to prevent recurrent cystitis. […] VUR is a dynamic diagnosis that must be managed on a case-by-case basis to determine the best care for each individual patient.

• #67 Machine learning-based prediction of vesicoureteral reflux outcomes in infants under antibiotic prophylaxis | Scientific Reports

  https://www.nature.com/articles/s41598-025-92847-3

  We aimed to investigate the independent outcome predictors of continuous antibiotic prophylaxis (CAP) in vesicoureteral reflux, train a model to predict the outcome, and evaluate which infants should be referred for endoscopic vesicoureteral reflux correction in their first visits. […] In conclusion, renal scarring and bladder dysfunction were predictors of vesicoureteral reflux outcomes when the infant was receiving CAP. Therefore, referring these patients to a urologist is advised during their first visits as they benefit from endoscopic injection. […] The optimal method for treating VUR in infants is controversial, and the best selection method to treat the patients with CAP or to refer them to a urologist for surgical intervention is lacking. […] We therefore suggest referring patients with renal scarring and/or bladder dysfunction to a urologist for surgical intervention at first visits by pediatricians/nephrologists.

• #68 Machine learning-based prediction of vesicoureteral reflux outcomes in infants under antibiotic prophylaxis | Scientific Reports

  https://www.nature.com/articles/s41598-025-92847-3

  Renal scarring and bladder dysfunction should be considered important predictors of breakthrough fUTI and/or renal scarring and VUR persistence, respectively, when the patient is receiving CAP. Therefore, referring these patients to a urologist for surgical intervention is suggested at first visits by pediatricians/nephrologists.

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