From the Guidelines
Antimicrobial prophylaxis is the recommended initial treatment for grade 2 vesicoureteral reflux (VUR) in children, as it helps prevent recurrent infections while allowing for the possibility of spontaneous resolution. This approach is supported by the European Association of Urology and European Society for Paediatric Urology guidelines, which suggest that continuous antibiotic prophylaxis (CAP) may not be required in every VUR patient, but can be considered until bladder and bowel dysfunction (BBD) resolution 1. The guidelines also recommend initial medical management for children with febrile UTI and high-grade VUR, with surgical options reserved for CAP noncompliance, breakthrough febrile UTIs despite CAP, and symptomatic VUR that persists during long-term follow-up.
Some key points to consider in the management of grade 2 VUR include:
- The main management goal is preservation of renal function
- Regular follow-up involves imaging and monitoring of height and weight, as well as blood pressure and possibly serum creatinine to monitor spontaneous resolution of VUR and evaluate kidney status
- BBD is common in toilet-trained children presenting with UTI with or without primary VUR and increases the risk of febrile UTI and focal uptake defects on a radionuclide scan
- Endoscopic subureteric injection of bulking agents is an alternative to long-term antibiotic prophylaxis and open surgical intervention in the treatment of VUR in children, with a reflux resolution rate of 78.5% for grade I and II reflux 1
Overall, the treatment of grade 2 VUR should be individualized and based on a risk analysis, taking into account the presence of BBD, the severity of the reflux, and the patient's overall health and development. Antimicrobial prophylaxis remains the best initial treatment option, with surgical intervention reserved for cases where medical management is not effective or feasible.
From the Research
Treatment for Grade 2 Vesicoureteral Reflux (VUR)
The recommended treatment for grade 2 VUR is not explicitly stated in the provided studies. However, some general guidelines for the management of VUR and urinary tract infections (UTIs) can be found:
- Antibiotic prophylaxis is indicated in children with moderate to high-grade (III-V) VUR to prevent recurrent febrile UTI 2.
- For children with febrile UTI, renal and bladder ultrasonography (RBUS) should be routinely performed as soon as possible, and RBUS should be followed up 6 months later in children with acute pyelonephritis and/or VUR 2.
- Surgical intervention may be used to treat VUR in the setting of recurrent febrile UTI because it has been shown to decrease the incidence of recurrent pyelonephritis 2.
- Some key recommendations for the management of UTI and VUR include:
- Urine culture with >104 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong 3.
- Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7-10 days 3.
- Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2 years of age with non-E. coli UTI 3.
- Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3-5) VUR 3.
- Antibiotic prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR 3.
Considerations for Grade 2 VUR
Some considerations for the management of grade 2 VUR include: