Vesicoureteral Reflux Treatment: Antibiotic Prophylaxis and Surgical Correction Strategies

The vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract in children, characterized by the retrograde flow of urine from the bladder to the ureters and potentially to the kidneys. This condition can lead to recurrent urinary tract infections (UTIs) and renal scarring, underscoring the importance of appropriate management. The treatment of VUR focuses on antibiotic prophylaxis and surgical correction, depending on the severity of the reflux and the patient's response to initial therapies.

Focus on Vesicoureteral Reflux Treatment

Antibiotic prophylaxis has traditionally been a strategy to prevent UTIs in children with VUR. However, its efficacy has been questioned due to increasing antibiotic resistance and associated adverse effects. Recent studies suggest that continuous prophylaxis may not be necessary in all patients with VUR, especially in those with lower grades of reflux or without bladder and bowel dysfunction (BBD) [1]. Instead, a close monitoring approach and immediate antibiotic treatment upon UTI episodes are recommended [2].

Surgical correction is generally reserved for cases of high-grade VUR, recurrent febrile UTIs despite prophylaxis, or when there is evidence of progressive renal damage. Surgical options include ureteral reimplantation using open, laparoscopic, or endoscopic techniques. Endoscopic injection of dextranomer/hyaluronic acid copolymer (Deflux) has gained popularity as a minimally invasive alternative with success rates comparable to open surgery [3]. However, the choice of treatment should be individualized, considering factors such as the patient's age, the degree of reflux, and parental preferences [4].

Conclusions

The management of vesicoureteral reflux in children requires a balanced approach that considers both antibiotic prophylaxis and surgical correction. Close monitoring and timely treatment of UTIs are essential to prevent long-term complications such as renal scarring. The decision to intervene surgically should be based on a careful assessment of risks and benefits, tailored to the individual characteristics of the patient. Ongoing research and updates to clinical guidelines are crucial for optimizing VUR treatment and improving long-term outcomes.

Referencias

• [1] Primary Vesicoureteral Reflux and Renal Scarring
• [2] Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group
• [3] Evaluation of new Deflux administration techniques: intraureteric HIT and Double HIT for the endoscopic correction of vesicoureteral reflux
• [4] Controversies in the Management of Vesicoureteral Reflux

Created 6/1/2025