Editing AUA: Vesicoureteral Reflux (2017) (section)

== Surgical treatment of VUR ==

=== <span style="color:#ff0000">Indications (3): ===
# '''<span style="color:#ff0000">Recurrent infections </span>[failure of CAP or CAP not used due to patient preference]'''
# '''<span style="color:#ff0000">New renal abnormalities on DMSA imaging'''
# '''<span style="color:#ff0000">Parental preference'''

=== Options ===

#'''<span style="color:#ff0000">Ureteral reimplantation'''
#'''<span style="color:#ff0000">Endoscopic injection of bulking agents'''

==== Comparison of Options ====

* '''<span style="color:#ff0000">Ureteral reimplantation has higher resolution rates'''
**Resolution rate is ≈98% for open surgery and ≈83% for endoscopic therapy after a single injection of bulking agent
* '''Endoscopic injection of bulking agents is less morbid'''
*'''Data demonstrating the durability of endoscopic therapy for VUR are limited'''
* Postoperative UTIs can occur with either treatment, but are more likely to occur in patients with a prior history of frequent UTIs

'''<span style="color:#ff0000">Post-operative follow-up'''
* '''<span style="color:#ff0000">Ureteral reimplantation'''
**'''<span style="color:#ff0000">Renal US should be obtained to assess for obstruction'''
*** While an infrequent occurrence, urinary obstruction may be "clinically silent" and have severe consequences that could be readily corrected.
**'''<span style="color:#ff0000">Voiding cystography is optional'''
* '''<span style="color:#ff0000">Endoscopic injection of bulking agents'''
**'''<span style="color:#ff0000">Voiding cystography is recommended'''