Surgical management of vesicoureteral reflux in children


Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0–21%, new renal damage in 9–12%, and recurrent reflux in 17–47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment.

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Vesicoureteral reflux


Dextranomer/hyaluronic acid


Urinary tract infection


Urogenital sinus


Ureterovesical junction


Voiding cystourethrography


Radionuclide cystogram




Subureteric Teflon injection


Hydrodistention implantation technique


99mTechnetium-dimercaptosuccinic acid


American Urological Association


Continuous antibiotic prophylaxis


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Correspondence to Steven Skoog.

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Sung, J., Skoog, S. Surgical management of vesicoureteral reflux in children. Pediatr Nephrol 27, 551–561 (2012).

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  • Vesicoureteral reflux
  • Endoscopy
  • Surgery
  • Laparoscopy
  • Uropathy