Critical appraisal of the top-down approach for vesicoureteral reflux

“Traditionally, it was mistakenly believed that every reflux should be identified and promptly treated to prevent UTI and minimize the risk of renal damage.”

“VCUG remains the gold standard tool to identify VUR. However, the test is usually a traumatic experience to both patients and their families due to the need for catheterization. Additionally, it carries a risk of introducing infection into the urinary tract. More importantly, it identifies a population with clinically-insignificant VUR that may never come to clinical attention, leading to potential overtreatment.”