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Vesicoureteral Reflux
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Vesicoureteral reflux (VUR)
          • Synonyms

            • Vesicoureteric reflux
          • Definitions

            • Retrograde urine flow from bladder toward kidney(s)

          IMAGING

          • General Features

            • Fluoroscopic Findings

              • Ultrasonographic Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    Selected References

                                    1. Kim D et al: Contrast-enhanced voiding urosonography for the diagnosis of vesicoureteral reflux and intrarenal reflux: a comparison of diagnostic performance with fluoroscopic voiding cystourethrography. Ultrasonography. 40(4):530-7, 2021
                                    2. Ntoulia A et al: Contrast-enhanced voiding urosonography, part 1: vesicoureteral reflux evaluation. Pediatr Radiol. ePub, 2021
                                    3. Janssen KM et al: Standardized protocol for voiding cystourethrogram: are recommendations being followed? J Pediatr Urol.17(1):66.e1-6, 2020
                                    4. Ji D et al: Accuracy of subjective vesicoureteral reflux timing assessment: supporting new voiding cystourethrogram guidelines. Pediatr Radiol. 50(7):953-7, 2020
                                    5. Walawender L et al: Diagnosis and imaging of neonatal UTIs. Pediatr Neonatol. 61(2):195-200, 2020
                                    6. Arlen AM et al: New trends in voiding cystourethrography and vesicoureteral reflux: who, when and how? Int J Urol. 26(4):440-5, 2019
                                    7. Capone V et al: Voiding cystourethrography and 99MTC-MAG3 renal scintigraphy in pediatric vesicoureteral reflux: what is the role of indirect cystography? J Pediatr Urol. 15(5):514.e1-6, 2019
                                    8. Garin EH: Primary vesicoureteral reflux; what have we learnt from the recently published randomized, controlled trials? Pediatr Nephrol. 34(9):1513-9, 2019
                                    9. Kosmeri C et al: An update on renal scarring after urinary tract infection in children: what are the risk factors? J Pediatr Urol. 15(6):598-603, 2019
                                    10. Rensing AJ et al: Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida. Pediatr Nephrol. 34(7):1277-82, 2019
                                    11. Schneider KO et al: Intrarenal reflux, an overlooked entity - retrospective analysis of 1,166 voiding cysturethrographies in children. Pediatr Radiol. 49(5):617-25, 2019
                                    12. Velasquez M et al: The learning curve of contrast-enhanced 'microbubble' voiding urosonography-validation study. J Pediatr Urol. 15(4):385.e1-6, 2019
                                    13. Kim HK et al: Feasibility of superb microvascular imaging to detect high-grade vesicoureteral reflux in children with urinary tract infection. Eur Radiol. 28(1):66-73, 2018
                                    14. Ntoulia A et al: Contrast-enhanced voiding urosonography (ceVUS) with the intravesical administration of the ultrasound contrast agent Optison™ for vesicoureteral reflux detection in children: a prospective clinical trial. Pediatr Radiol. 48(2):216-26, 2018
                                    15. Wang ZT et al: A reanalysis of the RIVUR trial using a risk classification system. J Urol. 199(6):1608-1614, 2018
                                    16. Duran C et al: Contrast-enhanced voiding urosonography for vesicoureteral reflux diagnosis in children. Radiographics. 37(6):1854-69, 2017
                                    17. Mattoo TK et al: Renal scarring in the randomized intervention for children with vesicoureteral reflux (RIVUR) Trial. Clin J Am Soc Nephrol. 11(1):54-61, 2016
                                    18. Weitz M et al: To screen or not to screen for vesicoureteral reflux in children with ureteropelvic junction obstruction: a systematic review. Eur J Pediatr. 176(1):1-9, 2016
                                    19. Bush NC et al: Renal damage detected by DMSA, despite normal renal ultrasound, in children with febrile UTI. J Pediatr Urol. 11(3):126.e1-7, 2015
                                    20. Mattoo TK et al: The RIVUR trial: a factual interpretation of our data. Pediatr Nephrol. 30(5):707-12, 2015
                                    21. Narchi H et al: Renal tract abnormalities missed in a historical cohort of young children with UTI if the NICE and AAP imaging guidelines were applied. J Pediatr Urol. 11(5):252.e1-7, 2015
                                    22. Stein R et al: Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol. 67(3):546-58, 2015
                                    23. Botta S et al: To V(CUG) or not to V(CUG) in infants with prenatal hydronephrosis? J Urol. 192(3):640-1, 2014
                                    24. Downs SM: UTI and watchful waiting: the courage to do nothing. Pediatrics. 133(3):535-6, 2014
                                    25. Hoberman A et al: Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 371(11):1072-3, 2014
                                    26. Kern AJ et al: Best of the 2014 AUA annual meeting: highlights from the 2014 american urological association annual meeting, May 16-21, 2014, Orlando, FL. Rev Urol. 16(3):139-44, 2014
                                    27. Ristola MT et al: NICE guidelines cannot be recommended for imaging studies in children younger than 3 years with urinary tract infection. Eur J Pediatr Surg. 25(5):414-20, 2014
                                    28. RIVUR Trial Investigators et al: Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 370(25):2367-76, 2014
                                    29. Suson KD et al: Evaluation of children with urinary tract infection--impact of the 2011 AAP guidelines on the diagnosis of vesicoureteral reflux using a historical series. J Pediatr Urol. 10(1):182-5, 2014
                                    30. Carpenter MA et al: The RIVUR trial: profile and baseline clinical associations of children with vesicoureteral reflux. Pediatrics. 132(1):e34-45, 2013
                                    31. La Scola C et al: Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics. 131(3):e665-71, 2013
                                    32. Tekgül S et al: EAU guidelines on vesicoureteral reflux in children. Eur Urol. 62(3):534-42, 2012
                                    33. Novljan G et al: Ultrasound detection of vesicoureteral reflux in children. J Urol. 184(1):319-24, 2010
                                    34. Shaikh N et al: Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 126(6):1084-91, 2010
                                    35. Taskinen S et al: Post-pyelonephritic renal scars are not associated with vesicoureteral reflux in children. J Urol. 173(4):1345-8, 2005
                                    36. Fernbach SK et al: Pediatric voiding cystourethrography: a pictorial guide. Radiographics. 20(1):155-68; discussion 168-71, 2000
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Vesicoureteral reflux (VUR)
                                            • Synonyms

                                              • Vesicoureteric reflux
                                            • Definitions

                                              • Retrograde urine flow from bladder toward kidney(s)

                                            IMAGING

                                            • General Features

                                              • Fluoroscopic Findings

                                                • Ultrasonographic Findings

                                                  • Nuclear Medicine Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Staging, Grading, & Classification

                                                            • Gross Pathologic & Surgical Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      Selected References

                                                                      1. Kim D et al: Contrast-enhanced voiding urosonography for the diagnosis of vesicoureteral reflux and intrarenal reflux: a comparison of diagnostic performance with fluoroscopic voiding cystourethrography. Ultrasonography. 40(4):530-7, 2021
                                                                      2. Ntoulia A et al: Contrast-enhanced voiding urosonography, part 1: vesicoureteral reflux evaluation. Pediatr Radiol. ePub, 2021
                                                                      3. Janssen KM et al: Standardized protocol for voiding cystourethrogram: are recommendations being followed? J Pediatr Urol.17(1):66.e1-6, 2020
                                                                      4. Ji D et al: Accuracy of subjective vesicoureteral reflux timing assessment: supporting new voiding cystourethrogram guidelines. Pediatr Radiol. 50(7):953-7, 2020
                                                                      5. Walawender L et al: Diagnosis and imaging of neonatal UTIs. Pediatr Neonatol. 61(2):195-200, 2020
                                                                      6. Arlen AM et al: New trends in voiding cystourethrography and vesicoureteral reflux: who, when and how? Int J Urol. 26(4):440-5, 2019
                                                                      7. Capone V et al: Voiding cystourethrography and 99MTC-MAG3 renal scintigraphy in pediatric vesicoureteral reflux: what is the role of indirect cystography? J Pediatr Urol. 15(5):514.e1-6, 2019
                                                                      8. Garin EH: Primary vesicoureteral reflux; what have we learnt from the recently published randomized, controlled trials? Pediatr Nephrol. 34(9):1513-9, 2019
                                                                      9. Kosmeri C et al: An update on renal scarring after urinary tract infection in children: what are the risk factors? J Pediatr Urol. 15(6):598-603, 2019
                                                                      10. Rensing AJ et al: Radiographic abnormalities, bladder interventions, and bladder surgery in the first decade of life in children with spina bifida. Pediatr Nephrol. 34(7):1277-82, 2019
                                                                      11. Schneider KO et al: Intrarenal reflux, an overlooked entity - retrospective analysis of 1,166 voiding cysturethrographies in children. Pediatr Radiol. 49(5):617-25, 2019
                                                                      12. Velasquez M et al: The learning curve of contrast-enhanced 'microbubble' voiding urosonography-validation study. J Pediatr Urol. 15(4):385.e1-6, 2019
                                                                      13. Kim HK et al: Feasibility of superb microvascular imaging to detect high-grade vesicoureteral reflux in children with urinary tract infection. Eur Radiol. 28(1):66-73, 2018
                                                                      14. Ntoulia A et al: Contrast-enhanced voiding urosonography (ceVUS) with the intravesical administration of the ultrasound contrast agent Optison™ for vesicoureteral reflux detection in children: a prospective clinical trial. Pediatr Radiol. 48(2):216-26, 2018
                                                                      15. Wang ZT et al: A reanalysis of the RIVUR trial using a risk classification system. J Urol. 199(6):1608-1614, 2018
                                                                      16. Duran C et al: Contrast-enhanced voiding urosonography for vesicoureteral reflux diagnosis in children. Radiographics. 37(6):1854-69, 2017
                                                                      17. Mattoo TK et al: Renal scarring in the randomized intervention for children with vesicoureteral reflux (RIVUR) Trial. Clin J Am Soc Nephrol. 11(1):54-61, 2016
                                                                      18. Weitz M et al: To screen or not to screen for vesicoureteral reflux in children with ureteropelvic junction obstruction: a systematic review. Eur J Pediatr. 176(1):1-9, 2016
                                                                      19. Bush NC et al: Renal damage detected by DMSA, despite normal renal ultrasound, in children with febrile UTI. J Pediatr Urol. 11(3):126.e1-7, 2015
                                                                      20. Mattoo TK et al: The RIVUR trial: a factual interpretation of our data. Pediatr Nephrol. 30(5):707-12, 2015
                                                                      21. Narchi H et al: Renal tract abnormalities missed in a historical cohort of young children with UTI if the NICE and AAP imaging guidelines were applied. J Pediatr Urol. 11(5):252.e1-7, 2015
                                                                      22. Stein R et al: Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol. 67(3):546-58, 2015
                                                                      23. Botta S et al: To V(CUG) or not to V(CUG) in infants with prenatal hydronephrosis? J Urol. 192(3):640-1, 2014
                                                                      24. Downs SM: UTI and watchful waiting: the courage to do nothing. Pediatrics. 133(3):535-6, 2014
                                                                      25. Hoberman A et al: Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 371(11):1072-3, 2014
                                                                      26. Kern AJ et al: Best of the 2014 AUA annual meeting: highlights from the 2014 american urological association annual meeting, May 16-21, 2014, Orlando, FL. Rev Urol. 16(3):139-44, 2014
                                                                      27. Ristola MT et al: NICE guidelines cannot be recommended for imaging studies in children younger than 3 years with urinary tract infection. Eur J Pediatr Surg. 25(5):414-20, 2014
                                                                      28. RIVUR Trial Investigators et al: Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 370(25):2367-76, 2014
                                                                      29. Suson KD et al: Evaluation of children with urinary tract infection--impact of the 2011 AAP guidelines on the diagnosis of vesicoureteral reflux using a historical series. J Pediatr Urol. 10(1):182-5, 2014
                                                                      30. Carpenter MA et al: The RIVUR trial: profile and baseline clinical associations of children with vesicoureteral reflux. Pediatrics. 132(1):e34-45, 2013
                                                                      31. La Scola C et al: Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics. 131(3):e665-71, 2013
                                                                      32. Tekgül S et al: EAU guidelines on vesicoureteral reflux in children. Eur Urol. 62(3):534-42, 2012
                                                                      33. Novljan G et al: Ultrasound detection of vesicoureteral reflux in children. J Urol. 184(1):319-24, 2010
                                                                      34. Shaikh N et al: Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 126(6):1084-91, 2010
                                                                      35. Taskinen S et al: Post-pyelonephritic renal scars are not associated with vesicoureteral reflux in children. J Urol. 173(4):1345-8, 2005
                                                                      36. Fernbach SK et al: Pediatric voiding cystourethrography: a pictorial guide. Radiographics. 20(1):155-68; discussion 168-71, 2000