Vesicoureteral Reflux

In the past 30 yr, the therapeutic approach to children with vesicoureteral reflux (VUR) has undergone a dynamic evolution from mainly surgery, as soon as VUR was detected, toward a conservative approach with antibiotic prophylaxis (stimulated and supported by results from the International Reflux Study in Children), to an endoscopic approach, and to the currently used active surveillance approach without prophylaxis. During those 30 yr, the diagnostic approach has not changed as much, although there is always an attempt to make the diagnosis of VUR while avoiding the "classic" voiding cystourethrogram (VCUG), which is one of the most stressing exams for a child and his or her family. Initially, radiographic grading of VUR was the only method of measuring the severity of VUR and of calculating the chance of spontaneous resolution. However, several other factors such as age, sex, presence of bladder and/or bowel dysfunction, presence of associated anatomic abnormalities, and laterality have been shown to have an influence on the spontaneous resolution rate. Based on the results of recent randomized studies (PRIVENT, Randomized Intervention for Children with Vesicoureteral Reflux [RIVUR], Swedish reflux study) and the updated VUR guidelines from the American Urological Association and the European Association of Urology European Society for Pediatric Urology, this review will give an overview of the important clinical features of VUR, the diagnostic methods, the computer models and nomograms to detect which children with VUR should be treated, and the options their respective chances of success for treating patients. It will become clear that the treatment selection and decision for treating VUR in a child is an individualized process. (C) 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.