Children with mild (grade I or II) vesicoureteral reflux

This algorithm reflects the management of mild VUR (grades I to II) that is diagnosed after a UTI, based on the approach of the authors. For any uncircumcised boy with VUR, the potential benefits of circumcision should also be discussed with the family. For details on VUR grading, refer to UpToDate content on diagnosis of primary VUR.

UTI: urinary tract infection; VUR: vesicoureteral reflux; BBD: bladder and bowel dysfunction; DMSA: dimercaptosuccinic acid.

* For details on antibiotic prophylaxis for VUR and surgical options, refer to UpToDate content on management of VUR.

¶ Follow-up care includes mandatory urine cultures and urinalysis with any episode of urinary symptoms suggestive of UTI or unexplained fever. Monitoring of VUR is done by either contrast voiding cystourethrogram or radionuclide cystogram and is typically performed in our practice every 18 to 24 months. In addition, DMSA renal scans are obtained in cases with breakthrough UTI.

Δ For details on the management and follow-up for BBD, refer to UpToDate content on bladder dysfunction and chronic functional constipation.

◊ Surgery is considered based on shared decision-making with the family. Surgery should be considered for persistent moderate or severe VUR that is unlikely to resolve, breakthrough UTI, difficulty adhering to medical management, new renal scarring, and significant adverse effects of prophylactic antibiotics. For details on the decisions regarding surgical correction and continuation and discontinuation of prophylactic antibiotics, refer to UpToDate topic on management of VUR.

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Children with mild (grade I or II) vesicoureteral reflux