The goal of treatment is to minimize infections, as it is infections that cause renal scarring and not the<unk> . Minimizing infections is primarily done by prophylactic antibiotics in newborns and infants who are not potty trained. However, in children who are older, physicians and parents should focus on bowel and bladder management. Children who hold their bladder or who are constipated have a greater number of infections than children who void on a regular schedule. When medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive renal scarring then surgical interventions may be necessary. Medical management is recommended in children with Grade I-III<unk>  as most cases will resolve spontaneously. A trial of medical treatment is indicated in patients with Grade IV<unk>  especially in younger patients or those with unilateral disease. Of the patients with Grade V<unk>  only infants are trialled on a medical approach before surgery is indicated, in older patients surgery is the only option. Endoscopic injection Endoscopic injection involves applying a gel around the ureteral opening to create a valve function and stop urine from flowing back up the ureter. The gel consists of two types of sugar-based molecules called dextranomer and hyaluronic acid. Trade names for this combination include<unk>  and Zuidex. Both constituents are well-known from previous uses in medicine. They are also biocompatible, which means that they do not cause significant reactions within the body. In fact, hyaluronic acid is produced and found naturally within the body. Medical treatment Medical treatment entails low dose antibiotic prophylaxis until resolution of<unk>  occurs. Antibiotics are administered nightly at half the normal therapeutic dose. The specific antibiotics used differ with the age of the patient and include: * Amoxicillin or ampicillin – infants younger than 6 weeks * Trimethoprim-sulfamethoxazole (co-trimoxazole) – 6 weeks to 2 months After 2 months the following antibiotics are suitable: * Nitrofurantoin {5–7 mg/kg/24hrs} * Nalidixic acid * Bactrim * Trimethoprim * Cephalosporins Urine cultures are performed 3 monthly to exclude breakthrough infection. Annual radiological investigations are likewise indicated. Good perineal hygiene, and timed and double voiding are also important aspects of medical treatment. Bladder dysfunction is treated with the administration of anticholinergics. Surgical management A surgical approach is necessary in cases where a breakthrough infection results despite prophylaxis, or there is non-compliance with the prophylaxis. Similarly if the<unk>  is severe (Grade IV & V), there are pyelonephritic changes or congenital abnormalities. Other reasons necessitating surgical intervention are failure of renal growth, formation of new scars, renal deterioration and<unk>  in girls approaching puberty. There are four types of surgical procedure available for the treatment of<unk> : endoscopic (STING/HIT procedures); laparoscopic; robotic-assisted laparoscopic; and open procedures (Cohen procedure, Leadbetter-Politano procedure, Lich-Gregoir technique). Laparoscopic and robotic-assisted laparoscopic procedures are often imitation of classical open procedures in laparoscopic or robotic-assisted laparoscopic environments. Surveillance The American Urological Association recommends ongoing monitoring of children with<unk>  until the abnormality resolves or is no longer clinically significant. The recommendations are for annual evaluation of blood pressure, height, weight, analysis of the urine, and kidney ultrasound.
Vesicoureteral reflux
Obstructive uropathy
Ureteric stricture
Glomerulonephrosis
Hydronephrosis
Urethral stricture
Pyelonephritis
Emphysematous cystitis