A 3-year-old girl presents with her third episode of UTI in 6 months. Urine culture grows E. coli >10^5 CFU/mL. After treatment, DMSA scan shows bilateral cortical scarring in the upper poles. MCUG reveals Grade III vesicoureteral reflux (VUR) on the right. What is the MOST appropriate long-term management?
- A Surgical ureteral reimplantation immediately
- B Continuous antibiotic prophylaxis and regular renal function monitoring ✓
- C Endoscopic submucosal injection of bulking agent (STING procedure)
- D No further treatment as most grade III VUR resolves spontaneously
Explanation
Grade III VUR in a 3-year-old with recurrent UTIs and evidence of existing renal scarring on DMSA is managed conservatively with continuous low-dose antibiotic prophylaxis (trimethoprim or nitrofurantoin) to prevent further UTIs and thus further renal scarring. Regular monitoring of renal function, blood pressure, and growth is essential. Surgical reimplantation is reserved for breakthrough UTIs on prophylaxis, Grade IV–V VUR, or failure of conservative management. Grade III VUR has a reasonable spontaneous resolution rate (~50% over 5 years) in younger children but given scarring, conservative management is still preferred over immediate surgery.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.