Children with moderate to severe (grades III to V) vesicoureteral reflux

This algorithm reflects the management of moderate to severe VUR (grades III to V) that is diagnosed after a UTI, based on the approach of the authors of the UpToDate content on management of VUR. Details for VUR grading can be found in the UpToDate content on presentation, diagnosis, and clinical course of primary VUR.

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

* For details on antibiotic prophylaxis for VUR and surgical options, refer to UpToDate content on management of VUR. Surgery should be considered for persistent grade IV and V VUR that is unlikely to resolve, breakthrough UTI, noncompliance with medical management, new renal scarring, and significant adverse effects of prophylactic antibiotics.

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

Δ 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. DMSA renal scan may be obtained; refer to UpToDate content on management of VUR for further details.

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Children with moderate to severe (grades III to V) vesicoureteral reflux