What pediatricians need to know about modern urologic management of vesicoureteral reflux

Jeanne Goulin^1,2,3Delphine Demède^1,3Bruno Ranchin⁴Melodie MOSCA^2,4Aurélie De Mul^2,4Valeska Bidault Jourdainne^1,2,3,5*

• ¹Pediatric urovisceral, thoracic and transplantation surgery department, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
• ²Université Claude Bernard Lyon 1, Lyon, Rhône-Alpes, France
• ³Centre de Références des Malformations Rares des Voies Urinaires (MARVU), BRON, France
• ⁴Pediatric nephrology, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
• ⁵INSERM U1208 Institut Cellule Souche et Cerveau, Bron, France

Vesicoureteral reflux (VUR) is a common urological disorder in children, and its prevalence is difficult to establish because a large proportion of these VUR remain silent and asymptomatic. VUR is considered nearly physiological during infancy and can disappear spontaneously during the first years of life. Most patients present with low-grade VUR, thought to be caused by an insufficient intramural course of the ureter in the bladder wall, that lengthens during first years' thriving. The worse the VUR grade is, the lower the probability of spontaneous resolution of this VUR during early childhood. Knowledge on pathophysiology of VUR and renal scarring has evolved over the past decades. Surgical correction of VUR is thus often discussed, but finally performed in very selected cases, mainly when high grade VUR persists with recurrent febrile UTI, and after voiding disorders correction in toilet-trained children.European and other international pediatric urology societies have edited guidelines for VUR management during childhood. Minimal invasive surgery becoming more and more common among pediatric urologists, treatment modalities have evolved, and endoscopic, laparoscopic and robotic-assisted procedures are now central parts of the surgical treatment. Updated ESPU/EAU guidelines have been released recently and are considered as a reference for pediatric urologists all around Europe. We review the recent literature and these guidelines, with the aim of providing pediatricians with up-to-date data on VUR pathophysiology, renal consequences and urological management.