Children with moderate to severe (grades III to V) VUR*

VUR: vesicoureteral reflux; UTI: urinary tract infection.
* This algorithm reflects the management of grades III to V VUR based on the approach of the authors of the UpToDate topic on management of VUR. 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. Surgery is considered for persistent grade IV and V VUR that is unlikely to resolve, breakthrough UTI, noncompliance with medical management, new renal scarring, and significant adverse effects of prophylactic antibiotics.
Δ 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.
◊ 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. DMSA (dimercaptosuccinic acid) renal scan may be obtained (refer to topic on management of VUR for further details).