title: Primary vesico-ureteric reflux: The need for individualised risk stratification.
abstract: The management of paediatric primary vesico-ureteric reflux (VUR) has undergone serial changes over the last decade. As this disorder is extremely heterogeneous, and high-quality prospective data are limited, the treatment strategies vary among centres. Current treatment options include observation only, continuous antibiotic prophylaxis, and surgery. Surgical intervention is indicated if a child has a breakthrough urinary tract infection (UTI) while on continuous antibiotic prophylaxis or if there are renal scars present. After excluding a secondary cause of VUR the physician should consider the risk factors affecting the severity of VUR and manage the child accordingly. Those factors include demographic factors (age at presentation, gender, ethnicity) and clinical factors (VUR grade, unilateral vs. bilateral, presence of renal scars, initial presentation, the number of UTIs, and presence of any voiding or bowel dysfunction). In this review we summarise the major controversial issues in current reports on VUR and highlight the importance of individualised patient management according to their risk stratification.
authors.affiliation: Urology Department, University of California, Irvine, Orange, CA, USA.
authors.forename: Guy
authors.initials: G
authors.lastname: Hidas
authors.affiliation: Urology Department, University of California, Irvine, Orange, CA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nam
authors.affiliation: Urology Department, University of California, Irvine, Orange, CA, USA.
authors.forename: Tandis
authors.initials: T
authors.lastname: Soltani
authors.affiliation: Urology Department, University of California, Irvine, Orange, CA, USA.
authors.forename: Maryellen
authors.initials: M
authors.lastname: Pribish
authors.affiliation: Urology Department, University of California, Irvine, Orange, CA, USA.
authors.forename: Blake
authors.initials: B
authors.lastname: Watts
authors.affiliation: Urology Department, University of California, Irvine, Orange, CA, USA.
authors.forename: Antoine E
authors.initials: AE
authors.lastname: Khoury
keywords: BBD, bladder and bowel dysfunction; Bladder and bowel dysfunctions; CAP, continuous antibiotic prophylaxis; Continuous antibiotic prophylaxis; Dimercaptosuccinic acid (DMSA); RCT, randomised control trial; Renal scars; US, ultrasonography; Urinary tract infection; VCUG, voiding cysto-urethrography; Vesico-ureteric reflux; Voiding cysto-urethrography