Vesicoureteral Reflux – Insights into Diagnosis and Management

Abstract

Abstract Vesicoureteral reflux (VUR) is the most common congenital condition of the urinary tract. A plethora of imaging methods and treatment plans are described in literature and are used in clinical practice. The aim of this article is to analyze the available diagnostic tests and the pharmaceutical, endoscopic, and surgical options of our therapeutic armamentarium. A literature search on the PubMed database was conducted by two writers. Randomized controlled trials and meta-analyses were included, all published in PubMed and in the English language from 2011 to this day. After reviewing the full texts, we excluded duplicates, papers regarding secondary disease and those without a pediatric reference population. Regarding the mostly used imaging tests, voiding cystourethrography is considered the reference method for the diagnosis and grading of the disease, but it entails exposure of patients to ionizing radiation. Voiding urosonography has a similar sensitivity but is highly dependent on the operator’s experience. Renal scintigraphy with dimercaptosuccinic acid remains a useful test for detecting renal scars. As far as management is concerned, continuous antibiotic prophylaxis, though previously doubted, remains a valid therapeutic option, especially for lower grades of VUR. Open surgical techniques and their modern–laparoscopic and robotic–variations are useful for dealing with high-grade disease, while endoscopic methods have sufficient efficacy and are utilized more and more. The diagnosis and treatment of VUR are constantly evolving areas. New diagnostic methods are replacing the older ones, while the treatment algorithm is individualized.