Children with mild (grade I or II) VUR*

VUR: vesicoureteral reflux; UTI: urinary tract infection.
* This algorithm reflects the management of grades I to II VUR based on the approach of the authors for the UpToDate topic on management of VUR. Of note, the potential benefits of circumcision are discussed with the family for any uncircumcised boy with VUR. Refer to topic on the risk and benefits of neonatal circumcision. Details for VUR grading can be found in the UpToDate topic on presentation, diagnosis, and clinical course of primary VUR.
¶ Details on antibiotic prophylaxis for VUR and surgical options are presented in the UpToDate topic on management of VUR.
Δ Follow-up care includes mandatory urine cultures and urinalysis whenever there are urinary symptoms suggestive of UTI or unexplained fever. Monitoring of VUR is done by either contrast voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC) and is typically performed in our practice every 18 to 24 months. In addition, DMSA (dimercaptosuccinic acid) renal scans are obtained in cases with breakthrough UTI.
◊ Details on the management measures for bladder and bowel dysfunction are presented in the UpToDate topics on bladder dysfunction and chronic functional constipation and fecal incontinence, and follow-up.
§ Surgery is considered based on family preference, due to persistent VUR and the need for monitoring by imaging, breakthrough UTI, noncompliance with medical management, significant adverse effects of prophylactic antibiotics, and development of a new renal scar. Details on management decisions regarding surgical correction and continuation and discontinuation of prophylactic antibiotics are presented in the UpToDate topic on management of VUR.