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Key Points

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  1. Primary vesicoureteral reflux (VUR)—the retrograde flow of urine from the bladder into the upper urinary tract—is the most common urological anomaly in children. It occurs in 1% to 2% of the pediatric population and in 30% to 50% of children who present with a urinary tract infection (UTI).

  2. The association of VUR, UTI, and renal damage is well known and refluxnephropathy is a major cause of childhood hypertension, growth impairment, and renal insufficiency.

  3. It is generally believed that discovering VUR early may prevent exposure to UTI, and this may avoid development or progression of renal parenchymal damage.

  4. Sonography should be performed in any infant or child with a suspicion of VUR. VUR is suspected in the presence of a dilated pelvicaliceal system, upper or lower ureter, unequal renal size, or cortical loss and increased echogenicity. Sonography is not sufficiently sensitive or specific for diagnosing VUR.

  5. A voiding cystogram remains the gold standard for detecting VUR.

  6. Management of VUR is controversial. The various treatment options currently available in the management of VUR are (i) long-term antibiotic prophylaxis, (ii) intermittent antibiotic therapy for UTI, (iii) antibiotic prophylaxis and anticholinergics, (iv) open or laparoscopic reimplantation of ureters, and (v) minimally invasive endoscopic treatment.

  7. Continuing antibiotics prophylaxis is reliant on patient's compliance and has the risk of bacterial resistance accompanied by potential breakthrough UTIs. Furthermore, several large, prospective, randomized controlled trials have shown little or no benefit of medical therapy in terms of reducing the incidence of febrile UTI or renal scarring

  8. Open surgical treatment of reflux has been the gold standard. However, surgery is not without risks.

  9. Minimally invasive endoscopic technique for the correction of VUR has become an established alternative to long-term antibiotic prophylaxis and open surgical treatment. Endoscopic subureteral injection of Deflux® is an excellent first-line treatment in children with 87% success in high-grade VUR after 1 injection. This 15-minute outpatient procedure is safe and simple to perform, and it can be easily repeated in failed cases.

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Introduction

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Primary vesicoureteral reflux (VUR)—the retrograde flow of urine from the bladder into the upper urinary tract—is the most common urological anomaly in children. It occurs in 1% to 2% of the pediatric population and in 30% to 50% of children who present with a urinary tract infection (UTI). The association of VUR, UTI, and renal damage is well known. Refluxnephropathy is a major cause of childhood hypertension, growth impairment, and renal insufficiency. Marra et al reviewed data on children with chronic renal failure who had high-grade VUR in the Italkid project, a database of Italian children with chronic renal failure and found that those with VUR accounted for 26% of all children with chronic renal failure.

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The hereditary and familial nature of VUR is now well recognized and several studies have shown that siblings of children with VUR have a much higher incidence of reflux than the general pediatric population. VUR can resolve ...

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