Articles

Vesicoureteral Reflux: Current Trends in Diagnosis, Screening, and Treatment

By: Jonathan C. Routha lowast , Guy A. Bogaertb, Martin Kaeferc, Gianantonio Manzonid, John M. Parke, Alan B. Retikf, H. Gil Rushtong, Warren T. Snodgrassh and Duncan T. Wilcoxi

Published online: 01 April 2012

Keywords: Vesicoureteral reflux, Pediatrics, Screening, Diagnosis, Treatment

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Abstract

Context

Vesicoureteral reflux (VUR) is present in approximately 1% of children in North America and Europe and is associated with an increased risk of pyelonephritis and renal scarring. Despite its prevalence and potential morbidity, however, many aspects of VUR management are controversial.

Objective

Review the evidence surrounding current controversies in VUR diagnosis, screening, and treatment.

Evidence acquisition

A systematic review was performed of Medline, Embase, Prospero, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, clinicaltrials.gov, and the most recent guidelines of relevant medical specialty organizations.

Evidence synthesis

We objectively assessed and summarized the published data, focusing on recent areas of controversy relating to VUR screening, diagnosis, and treatment.

Conclusions

The evidence base for many current management patterns in VUR is limited. Areas that could significantly benefit from additional future research include improved identification of children who are at risk for VUR-related renal morbidity, improved stratification tools for determining which children would benefit most from which VUR treatment option, and improved reporting of long-term outcomes of VUR treatments.

Take Home Message

Many aspects of vesicoureteral reflux (VUR) management are controversial, and the evidence base for many current management patterns is limited. We review the current literature surrounding VUR diagnosis, screening, and treatment.

Keywords: Vesicoureteral reflux, Pediatrics, Screening, Diagnosis, Treatment.

Footnotes

a Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA

b Department of Urology, University Hospitals Leuven, Leuven, Belgium

c Department of Urology, Indiana University and Riley Hospital for Children, Indianapolis, IN, USA

d Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milano, Italy

e Department of Urology, University of Michigan, Ann Arbor, MI, USA

f Department of Urology, Children's Hospital Boston, Boston, MA, USA

g Division of Urology, Children's National Medical Center, Washington, DC, USA

h Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

i Division of Urology, University of Colorado, Denver, CO, USA

lowast Corresponding author. Division of Urologic Surgery, Duke University Medical Center, DUMC Box 3831, Durham, NC 27710, USA. Tel. +1 919 684 6994; Fax: +1 919 681 5507.