Editing AUA: Vesicoureteral Reflux (2017) (section)

=== Management of VUR based on age (cut-off age 1 year) ===

==== Child age < 1 with VUR ====
* '''VUR resolution occurs in ≈50% of these children within 24 months'''
* Infants age < 1 may not show clinical evidence of pyelonephritis as clearly as older children and they may have a greater risk of infection-related morbidity.
* '''<span style="color:#ff0000">Continuous antibiotic prophylaxis (CAP)</span>'''
** '''<span style="color:#ff0000">Recommended in children age < 1 with (2):</span>'''
**# '''<span style="color:#ff0000">A history of a febrile UTI or</span>'''
**# '''<span style="color:#ff0000">VUR grade ≥III</span>''' who is identified through screening, even in the absence of a history of febrile UTIs
** '''<span style="color:#ff0000">Optional in children age < 1 with:</span>'''
*** '''<span style="color:#ff0000">VUR grades I–II</span>''' who is identified through screening, even in the absence of a history of febrile UTIs
* '''<span style="color:#ff0000">Circumcision</span>'''
** '''<span style="color:#ff0000">May be considered in the infant male with VUR</span>''' based on an increased risk of UTIs in boys who are not circumcised compared to those who are circumcised.
*** Although there are insufficient data to evaluate the degree of this increased risk and its duration, parents need to be made aware of this association to permit informed decision-making.

==== Child age > 1 with VUR ====
* Recommendations are somewhat different from those age < 1, due to:
** Greater likelihood of BBD
** Lower probability of spontaneous resolution of VUR
** Lower risk of acute morbidity from febrile UTI
** Greater ability of the child to verbally complain of symptoms to indicate acute infection
* '''<span style="color:#ff0000">Treatment of BBD, if present, is recommended, preferably before any surgical intervention for VUR</span>'''
** There are insufficient data to recommend a specific '''treatment regimen for BBD'''
** '''<span style="color:#ff0000">Treatment options for BBD (5):</span>'''
**# '''<span style="color:#ff0000">Behavioral therapy</span>'''
**# '''<span style="color:#ff0000">Biofeedback (appropriate for children age > 5)</span>'''
**# '''<span style="color:#ff0000">Treatment of constipation</span>'''
**# '''<span style="color:#ff0000">Anticholinergic medications</span>'''
**# '''<span style="color:#ff0000">Alpha blockers</span>'''
** Monitoring the response to BBD treatment is recommended to determine whether treatment should be maintained or modified.
* '''<span style="color:#ff0000">Indications for CAP in a child age > 1 year with VUR (3):</span>'''
*# '''<span style="color:#ff0000">BBD</span>'''
*# '''<span style="color:#ff0000">Recurrent febrile UTI</span>'''
*# '''<span style="color:#ff0000">Renal cortical abnormalities on imaging</span>'''
** '''<span style="color:#ff0000">In the absence of these features, CAP or observation,</span>''' with prompt initiation of antibiotic therapy for UTI, '''are options</span>'''