Vesicoureteral Reflux: Special Considerations and Specific Populations

Purpose of Review This review will hopefully serve as a brief update on the current approaches to vesicoureteral reflux (VUR) within the context of historical approaches to this disorder and dispelling some of the myths surrounding its treatment. There is also greater focus on certain populations with VUR that may (or may not) be at particular risk. Recent Findings Despite several large studies showing the benefit of antibiotic prophylaxis in preventing infections in VUR, there continues to be conflicting results in smaller scale studies or in regard to renal scarring that prevent its accepted use universally. Some of these conflicting results are a product of comparing a mixed population of individuals, as there are certain populations that seem to benefit from antibiotic prophylaxis and for which it should be considered. Similarly, surgical correction of VUR is not beneficial for many individuals even within certain higher risk populations, such as higher grade VUR, pre-pubertal females, and renal transplant recipients. Summary Preceding febrile infections and the presence of renal scarring are two indicators of higher risk individuals. However, renal scarring in some individuals may not be secondary to infections. Therefore, an individualized approach to each patient with VUR is needed, with some needing treatment by surgery, some needing antibiotic prophylaxis, some needing optimal bladder care, and even others needing treatment of the sequelae of renal scarring.