Nephro-Urology Monthly

Published by: Kowsar

Individualizing Management of Vesicoureteral Reflux

Christopher S. Cooper 1 , *
Author Information
1 Department of Urology, University of Iowa Department of Urology, Iowa, United States
Article information
  • Nephro-Urology Monthly: June 01, 2012, 4 (3); 530-534
  • Published Online: June 20, 2012
  • Article Type: Review Article
  • Received: July 18, 2011
  • Revised: August 1, 2011
  • Accepted: August 12, 2011
  • DOI: 10.5812/numonthly.1866

To Cite: S. Cooper C. Individualizing Management of Vesicoureteral Reflux, Nephro-Urol Mon. 2012 ; 4(3):530-534. doi: 10.5812/numonthly.1866.

Copyright © 2012, Nephrology and Urology Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. Antibiotics
3. Predictors of Resolution
4. Conclusions
  • 1. Cooper CS, Austin JC. Vesicoureteral reflux: who benefits from surgery? Urol Clin North Am. 2004; 31(3): 535-41[DOI][PubMed]
  • 2. Austin JC, Cooper CS. Vesicoureteral reflux: who benefits from correction. Urol Clin North Am. 2010; 37(2): 243-52[DOI][PubMed]
  • 3. Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol. 2010; 184(3): 1134-44[DOI][PubMed]
  • 4. Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children: five years’ observation. Birmingham Reflux Study Group. Br Med J (Clin Res Ed). 1987; 295(6592): 237-41
  • 5. Weiss R, Duckett J, Spitzer A. Results of a randomized clinical trial of medical versus surgical management of infants and children with grades III and IV primary vesicoureteral reflux (United States). The International Reflux Study in Children. J Urol. 1992; 148(5 Pt 2): 1667-73[PubMed]
  • 6. Reddy P, Evans M, Hughes P, Dangman B, Cooper J, Lepow M, et al. Antimicrobial prophylaxis in children with vesicoureteral reflux: a randomized prospective study of continuous therapy versus intermittent therapy versus surveillance. Pediatrics. 1997; 100: 555-6
  • 7. Cooper CS, Chung BI, Kirsch AJ, Canning DA, Snyder HM, 3rd.. The outcome of stopping prophylactic antibiotics in older children with vesicoureteral reflux. J Urol. 2000; 163(1): 269-72; discussion 72-3[DOI][PubMed]
  • 8. Thompson RH, Chen JJ, Pugach J, Naseer S, Steinhardt GF. Cessation of prophylactic antibiotics for managing persistent vesicoureteral reflux. J Urol. 2001; 166(4): 1465-9[DOI][PubMed]
  • 9. Hellerstein S, Nickell E. Prophylactic antibiotics in children at risk for urinary tract infection. Pediatr Nephrol. 2002; 17(7): 506-10[DOI][PubMed]
  • 10. Leslie B, Moore K, Salle JL, Khoury AE, Cook A, Braga LH, et al. Outcome of antibiotic prophylaxis discontinuation in patients with persistent vesicoureteral reflux initially presenting with febrile urinary tract infection: time to event analysis. J Urol. 2010; 184(3): 1093-8[DOI][PubMed]
  • 11. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA. 2007; 298(2): 179-86[DOI][PubMed]
  • 12. Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006; 117(3): 626-32[DOI][PubMed]
  • 13. Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 2008; 121(6)-94[DOI][PubMed]
  • 14. Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol. 2008; 179(2): 674-9; discussion 9[DOI][PubMed]
  • 15. Montini G, Rigon L, Zucchetta P, Fregonese F, Toffolo A, Gobber D, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. 2008; 122(5): 1064-71[DOI][PubMed]
  • 16. Brandstrom P, Esbjorner E, Herthelius M, Holmdahl G, Lackgren G, Neveus T, et al. The Swedish reflux trial in children: I. Study design and study population characteristics. J Urol. 2010; 184(1): 274-9[DOI][PubMed]
  • 17. Brandstrom P, Esbjorner E, Herthelius M, Swerkersson S, Jodal U, Hansson S. The Swedish reflux trial in children: III. Urinary tract infection pattern. J Urol. 2010; 184(1): 286-91[DOI][PubMed]
  • 18. Holmdahl G, Brandstrom P, Lackgren G, Sillen U, Stokland E, Jodal U, et al. The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. J Urol. 2010; 184(1): 280-5[DOI][PubMed]
  • 19. Brandstrom P, Neveus T, Sixt R, Stokland E, Jodal U, Hansson S. The Swedish reflux trial in children: IV. Renal damage. J Urol. 2010; 184(1): 292-7[DOI][PubMed]
  • 20. Sillen U, Brandstrom P, Jodal U, Holmdahl G, Sandin A, Sjoberg I, et al. The Swedish reflux trial in children: v. Bladder dysfunction. J Urol. 2010; 184(1): 298-304[DOI][PubMed]
  • 21. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010; 126(6): 1084-91[DOI][PubMed]
  • 22. Alsaywid BS, Saleh H, Deshpande A, Howman-Giles R, Smith GH. High grade primary vesicoureteral reflux in boys: long-term results of a prospective cohort study. J Urol. 2010; 184(4 Suppl): 1598-603[DOI][PubMed]
  • 23. Allen UD, MacDonald N, Fuite L, Chan F, Stephens D. Risk factors for resistance to "first-line" antimicrobials among urinary tract isolates of Escherichia coli in children. CMAJ. 1999; 160(10): 1436-40[PubMed]
  • 24. Paschke AA, Zaoutis T, Conway PH, Xie D, Keren R. Previous antimicrobial exposure is associated with drug-resistant urinary tract infections in children. Pediatrics. 2010; 125(4): 664-72[DOI][PubMed]
  • 25. Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, McTaggart SJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009; 361(18): 1748-59[DOI][PubMed]
  • 26. McMillan ZM, Austin JC, Knudson MJ, Hawtrey CE, Cooper CS. Bladder volume at onset of reflux on initial cystogram predicts spontaneous resolution. J Urol. 2006; 176(4 Pt 2): 1838-41[DOI][PubMed]
  • 27. Knudson MJ, Austin JC, McMillan ZM, Hawtrey CE, Cooper CS. Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux. J Urol. 2007; 178(4 Pt 2): 1684-8[DOI][PubMed]
  • 28. Estrada CR Jr, Passerott CC, Graham DA, Peters CA, Bauer SB, Diamond DA, et al. Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2,462 children. J Urol. 2009; 182(4): 1535-41[DOI][PubMed]
  • 29. Cannon GM Jr, Arahna AA, Graham DA, Passerotti CC, Silva A, Retik AB, et al. Improvement in vesicoureteral reflux grade on serial imaging predicts resolution. J Urol. 2010; 183(2): 709-13[DOI][PubMed]
  • 30. Knudson MJ, Austin JC, Wald M, Makhlouf AA, Niederberger CS, Cooper CS. Computational model for predicting the chance of early resolution in children with vesicoureteral reflux. J Urol. 2007; 178(4 Pt 2): 1824-7[DOI][PubMed]
  • 31. Shiraishi K, Matsuyama H, Nepple KG, Wald M, Niederberger CS, Austin CJ, et al. Validation of a prognostic calculator for prediction of early vesicoureteral reflux resolution in children. J Urol. 2009; 182(2): 687-90; discussion 90-1[DOI][PubMed]
  • 32. Nepple KG, Knudson MJ, Austin JC, Cooper CS . Abnormal renal scans and decreased early resolution of low grade vesicoureteral reflux. J Urol. 2008; 180(4 Suppl): 1643-7; discussion 7[DOI][PubMed]
  • 33. Sjostrom S, Sillen U, Jodal U, Sameby L, Sixt R, Stokland E. Predictive factors for resolution of congenital high grade vesicoureteral reflux in infants: results of univariate and multivariate analyses. J Urol. 2010; 183(3): 1177-84[DOI][PubMed]
  • 34. Nepple KG, Knudson MJ, Austin JC, Wald M, Makhlouf AA, Niederberger CS, et al. Adding renal scan data improves the accuracy of a computational model to predict vesicoureteral reflux resolution. J Urol. 2008; 180(4 Suppl): 1648-52; discussion 52[DOI][PubMed]
  • 35. Nepple KG, Arlen AM, Austin JC, Cooper CS. The prognostic impact of an abnormal initial renal ultrasound on early reflux resolution. J Pediatr Urol. 2012; 7(4): 462-6[DOI][PubMed]
Readers' Comments