Primary vesicoureteral reflux; what have we learnt from the recently published randomized, controlled trials?

Pediatr Nephrol. 2019 Sep;34(9):1513-1519. doi: 10.1007/s00467-018-4045-9. Epub 2018 Aug 21.


In recent years, progress has been made on understanding the relationship between vesicoureteral reflux (VUR) and urinary tract infection (UTI). The findings on recent prospective, randomized, controlled studies have questioned the conventional VUR clinical significance and, therefore, have challenged the traditional diagnostic and therapeutic recommendations. These new studies have redefined the pathogenic role of vesicoureteral reflux in UTI as well as have disputed the routine use of urinary antibiotic prophylaxis to prevent UTI and renal damage in VUR patients. The time to overinvestigate and treat the vast majority of otherwise healthy children who have an uncomplicated UTI with long-term antibiotic prophylaxis seems to be over. Is there a role of severe VUR in the development of chronic renal disease and renal failure? New ideas are needed to answer these questions with the goal to avoid repeating past mistakes when therapeutic choices were based on expert opinions rather than facts.

Keywords: Urinary antibiotic prophylaxis; Urinary tract infection; Vesicoureteral reflux.

Publication types

  • Review

MeSH terms

  • Antibiotic Prophylaxis / adverse effects
  • Antibiotic Prophylaxis / standards*
  • Child
  • Cystography
  • Evidence-Based Medicine / standards
  • Humans
  • Kidney Cortex / pathology
  • Kidney Medulla / pathology
  • Nephrology / standards
  • Practice Guidelines as Topic*
  • Prevalence
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Secondary Prevention / standards
  • Treatment Outcome
  • Ureter / abnormalities
  • Ureter / diagnostic imaging
  • Urinary Bladder / abnormalities
  • Urinary Bladder / diagnostic imaging
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / etiology
  • Urinary Tract Infections / prevention & control*
  • Vesico-Ureteral Reflux / complications*
  • Vesico-Ureteral Reflux / congenital
  • Vesico-Ureteral Reflux / diagnosis
  • Vesico-Ureteral Reflux / epidemiology