[Vesicoureteral reflux : Watchful waiting, surgery or antibiotic prophylaxis?]

Primary vesicoureteral reflux (VUR) is a dynamic disease with several factors influencing its course. Therapeutic options range from watchful waiting to open surgery. Multiple risk factors for the development of pyelonephritis are identified, which then determine the decision for the appropriate treatment option. They include age, gender, history of pyelonephritis and renal scarring, bladder and bowel dysfunction (BBD), circumcision status and parental preference. The use of continuous antibiotic prophylaxis (CAP) is becoming increasingly controversial with antibiotic resistance being a major concern. Aggressive treatment of BBD and infant circumcision can greatly reduce the risk for pyelonephritis and should always be considered and discussed. This article is soley concerned with primary VUR.