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  • Review Article
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Therapy Insight: what nephrologists need to know about primary vesicoureteral reflux

Nature Clinical Practice Nephrology volume 3, pages 551–563 (2007)Cite this article

Abstract

Vesicoureteral reflux (VUR) is the abnormal, retrograde flow of urine from the bladder to the upper urinary tract. This disease affects about 1% of otherwise normal children, 30–50% of those who present with urinary tract infections, and approximately 10% with prenatally diagnosed hydronephrosis. Over the past 50 years, tremendous progress has been made in the diagnosis, treatment and management of VUR. The realization that VUR is probably a component of generalized dysfunction of the lower urinary tract (i.e. dysfunctional elimination syndrome) has further enhanced understanding of the disease. This Review covers basic pathogenesis, diagnosis, management, clinical presentation, and current controversies surrounding VUR.

Key Points

  • Primary vesicoureteral reflux (VUR) probably involves both an anatomic deficiency at the ureterovesical junction as well as generalized dysfunction of the lower urinary tract

  • 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

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Figure 1: International Reflux Grading classification scheme for vesicoureteral reflux.116
Figure 2: Anatomic abnormalities associated with vesicoureteral reflux.

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. PC Gargollo is a board-eligible urologist, instructor of surgery at Harvard Medical School, and a fellow in pediatric urology at Children's Hospital Boston, and DA Diamond is Associate Professor of Surgery (Urology) at Harvard Medical School and Associate in Urology at Children's Hospital Boston, Boston, MA, USA.,

    Patricio C Gargollo & David A Diamond

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Gargollo, P., Diamond, D. Therapy Insight: what nephrologists need to know about primary vesicoureteral reflux. Nat Rev Nephrol 3, 551–563 (2007). https://doi.org/10.1038/ncpneph0610

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