This handout is for pediatric vesicoureteral reflux (vur) — grade i–v; primary / secondary / antenatal-hydronephrosis pathway; prophylaxis / surgical / behavioural management. Your care team identified this based on: vcug-positive vesicoureteral reflux (grade i–v) — entry to vur pathway (aap 2011; aua pediatric vur).
Other reasons your team may use this plan: first febrile uti 2–24 mo with renal + bladder us findings → vcug planning (aap 2011); recurrent febrile uti (≥2 in 6 mo or ≥3 in 12 mo) → vur workup (aap 2011); antenatal hydronephrosis on prenatal us → postnatal renal + bladder us within 3–7 d → vcug if persistent (nice ng224).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| Behavioural therapy — scheduled voiding, double voiding, hydration, posture education | — | — | — | AAP 2011 / RIVUR — BBD is dominant modifiable risk factor; treat before deciding prophylaxis vs surgery |
| polyethylene glycol 3350 (PEG) | 0.4–0.8 g/kg/day PO (max 17 g/day) | PO | once daily | AAP — constipation contributes to BBD and UTI risk; PEG first-line in pediatric constipation |
| Route to uro.urinary-incontinence-eval.v1 for full BBD workup | — | — | — | AAP 2011 — formal BBD pathway covers ICIQ-like assessment + behavioural ladder |
Plan: AAP / AUA / RIVUR / PRIVENT — bowel-bladder dysfunction first → grade-tiered observation vs continuous prophylaxis (TMP-SMX or nitrofurantoin) × 6–12 mo → ureteral reimplantation / endoscopic Deflux + circumcision counseling + breakthrough management
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Trial off prophylaxis after 6–12 mo if no breakthroughs in moderate; transition to adult care; counsel lifelong HTN surveillance + pregnancy considerations if scarring; family screening for siblings (AAP 2011)
Guideline: AUA Guideline on Management of Primary Vesicoureteral Reflux in Children (Peters CA et al, J Urol 2010 PMID 20650499). Supporting evidence cited by name: AAP UTI 2011/2016 reaffirmation, RIVUR Trial (NEJM 2014) and PRIVENT Trial for continuous antibiotic prophylaxis, NICE pediatric UTI guidance, DMSA imaging consensus.