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Vesicoureteral Reflux (VUR) • After treatment and follow-up

When Is a Follow-up VCUG Required?

In a child diagnosed with vesicoureteral reflux (VUR), the first VCUG (voiding cystourethrogram; informally, the “catheter film”) is unavoidable; however, how often it should be repeated afterward is one of the questions families ask most, and one where practice varies most between centers. Current guidelines keep repeat studies to a minimum: this page explains three separate policies — for observation, after injection, and after surgery.

Who this is forFamilies of children in observation or post-treatment follow-up, for whom a follow-up study is being considered
Reading≈6 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of vesicoureteral reflux.Read the full treatment overview on the hub page
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VCUG: contrast given via a catheter flows back from the bladder into the ureter
01 · A study isn't done at every check-up: radiation, catheter, and anxiety02 · During observation (on antibiotic prophylaxis or under watchful waiting): routine repeat not needed03 · After endoscopic injection: VCUG or ceVUS at 3–6 months04 · After open reimplantation: no study needed if ultrasound is normal and there is no infection05 · ceVUS and other radiation-free options
In brief5 madde
  • A study isn't done at every check-up: radiation, catheter, and anxiety: A VCUG involves giving contrast material into the bladder through a catheter and taking X-ray images during filling and voiding; it is the only method that shows…
  • During observation (on antibiotic prophylaxis or under watchful waiting): routine repeat not needed: In a child with low-grade (I–II) reflux and no infections, spontaneous resolution with growth is expected; this process takes years, and getting a study every year…
  • After endoscopic injection: VCUG or ceVUS at 3–6 months: The success of the injection can only be shown with a voiding study; ultrasound shows where the bulking agent is but not whether reflux is present.
  • After open reimplantation: no study needed if ultrasound is normal and there is no infection: Ureteral reimplantation is 95–98% successful in the literature.
  • ceVUS and other radiation-free options: ceVUS (contrast-enhanced voiding urosonography) is a radiation-free voiding study performed by giving ultrasound contrast material into the bladder through a…
01

A study isn't done at every check-up: radiation, catheter, and anxiety

A VCUG involves giving contrast material into the bladder through a catheter and taking X-ray images during filling and voiding; it is the only method that shows reflux and its grade. On the other hand, every repeat means catheter placement, discomfort during the procedure, and radiation, even if at a low dose, for the child. For this reason, current guidelines recommend a study only when the result would change the treatment decision.

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  • The question to ask is: “If this study shows reflux persisting or resolved, what will we do?” If the answer is the same either way (for example, continuing observation in a low-grade child with no infections), the study can be postponed. If the answer differs (stopping antibiotic prophylaxis, seeing whether the injection succeeded, deciding on surgery), a study is needed.
  • Modern VCUG equipment delivers a low radiation dose (pulsed fluoroscopy); still, radiation-free options are preferred especially in girls and for repeat studies. Our doctors weigh every repeat study against this question and make the decision together with you.
02

During observation (on antibiotic prophylaxis or under watchful waiting): routine repeat not needed

In a child with low-grade (I–II) reflux and no infections, spontaneous resolution with growth is expected; this process takes years, and getting a study every year does not speed up resolution. Clinical follow-up (are there febrile infections?) and yearly ultrasound are enough; a study is considered only every 12–24 months, and even then only if the result would affect a decision.

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  • Typical situations that make a repeat study meaningful: wanting to confirm reflux has resolved before stopping antibiotic prophylaxis (CAP), deciding on injection after assessing whether improvement has occurred following several years of observation for moderate-to-high grade, and having a febrile infection during observation. After about age 5, low-grade reflux has usually either resolved or lost its clinical significance; many centers space out follow-up rather than repeating the study at this point.
  • Some centers request a single follow-up study after CAP is stopped to document that the reflux has resolved; others do not perform one at all if there is no infection. Both approaches are acceptable; discuss which will be used with your team beforehand.
03

After endoscopic injection: VCUG or ceVUS at 3–6 months

The success of the injection can only be shown with a voiding study; ultrasound shows where the bulking agent is but not whether reflux is present. For this reason, most centers request a follow-up study 3–6 months after the procedure; timing varies by center. If the study shows the reflux has resolved, CAP is stopped; if it persists, repeat injection or surgery is discussed.

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  • Some centers also skip the post-injection study in a low-grade, infection-free child and follow with ultrasound alone; however, because late recurrence has been reported in the literature and the CAP decision depends on this result, our doctors recommend a follow-up study. Radiation-free ceVUS is particularly suitable for this purpose.
  • If no reflux remains on the follow-up study, a routine study is not needed in subsequent years; reflux is reassessed if a febrile infection occurs.
04

After open reimplantation: no study needed if ultrasound is normal and there is no infection

Ureteral reimplantation is 95–98% successful in the literature. At such a high success rate, performing a study on every child means a large number of unnecessary catheterizations and radiation exposures; since the AUA 2010 guideline, a postoperative VCUG has been an option, not a requirement. Our approach: ultrasound at 4–6 weeks and at around 1 year; if the ultrasound is normal and there is no febrile infection, no study is performed.

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  • Exceptions that require a study: a febrile UTI after surgery, new or increased kidney dilation on ultrasound, complex cases (repeat surgery, duplex system, neurogenic bladder), and the family wanting to document the outcome. In laparoscopic/robot-assisted reimplantation, the study policy may differ depending on the center's experience; your team will tell you their own practice.
  • If a postoperative study is to be performed, its timing is generally 3–6 months later; it should be done after the healing-related swelling has subsided.
05

ceVUS and other radiation-free options

ceVUS (contrast-enhanced voiding urosonography) is a radiation-free voiding study performed by giving ultrasound contrast material into the bladder through a catheter; it shows reflux and its grade with accuracy close to VCUG, and is particularly preferred in girls, for sibling screening, and for repeat studies. Catheter placement is still needed; because it does not show the urethra's anatomy as well as VCUG, VCUG is preferred at first diagnosis when there is suspicion of posterior urethral valves in a male infant.

  • First diagnosis, male infant, question about the urethra: VCUG.
  • Follow-up after injection: VCUG or ceVUS (depending on the center).
  • Repeat study in a girl, sibling screening: ceVUS preferred.
  • Only the question “is reflux still present?”: ceVUS or RNC is enough.
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  • Radionuclide cystography (RNC) is also a low-dose, radiation-based repeat option; grade differentiation is coarse, but it reliably shows whether reflux is present or absent. The number of centers performing ceVUS is still limited; your team can refer you to a suitable center.
  • Whichever method is chosen, the study is done while there is no infection; a single dose of antibiotic is given on the day of the procedure if needed. Tips for preparing and reassuring your child are described under how VCUG is performed.
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Frequently asked questions
A year has passed — is a follow-up study required?
Not in a low-grade, infection-free child under observation; clinical follow-up and yearly ultrasound are enough. A study is considered only if the result would change a decision (stopping the antibiotic, injection), and generally every 12–24 months.
We want to see that the reflux is gone after surgery — can we have a study done?
Your request is understandable and can be offered as an option. However, because of the surgery's 95–98% success rate, a routine study is not recommended if the ultrasound is normal and there is no infection; if performed, it can be done 3–6 months later, preferably with radiation-free ceVUS.
What's the difference between ceVUS and VCUG — which is better?
Both require a catheter; ceVUS does not involve radiation and shows reflux with accuracy close to VCUG. VCUG shows the urethra better, so it is preferred at first diagnosis in male infants; ceVUS is preferred for repeat studies and in girls, where a suitable center is available.
Do we need antibiotics before the study?
The study is done while there is no infection; many centers recommend a single dose of antibiotic prophylaxis on the day of the procedure. If you are already taking CAP, continuing your medication is enough; your team will give you specific instructions.
←Previous • After treatment and follow-upIf a Febrile Urinary Tract Infection Occurs After TreatmentNext • After treatment and follow-upLong-Term Follow-up in VUR: Ultrasound, Blood Pressure, Urine, and Discharge from Follow-up→
Related pagesFull index →
Diagnosis and evaluationVCUG (Voiding Cystourethrogram): How It's Done, and PreparationThe VCUG (voiding cystourethrogram) is the main method that both shows and grades vesicoureteral reflux (VUR). A thin catheter is used to fill the bladder with contrast fluid; as the bladder fills and the child voids, it is imaged to see whether urine backs up into the kidney. This page explains how the procedure is done, how to prepare, radiation, and the alternatives.After treatment and follow-upEndoscopic Injection Aftercare and Follow-upEndoscopic injection (subureteral bulking; Deflux) for vesicoureteral reflux (VUR) is a day-case procedure; the child usually goes home the same day. This page explains what to expect from going home through the follow-up study, when antibiotic prophylaxis is stopped, and which findings should be reported to the doctor.After treatment and follow-upReimplantation Surgery Aftercare: Hospital Stay, Catheter, Home CareAfter vesicoureteral reflux surgery (ureteral reimplantation; re-implanting the ureter into the bladder), the child typically stays in the hospital for 1–3 days. The catheter, bladder spasms, and blood-tinged urine in the first days are what worry families most; this page explains step by step what to expect from the first day in the hospital through the return to school.Treatment pathwaysDoes Vesicoureteral Reflux Resolve on Its Own? Active SurveillanceFor families who have just received a diagnosis of vesicoureteral reflux (VUR), the first question is usually, 'Will it go away on its own?' For most children, the answer is yes — but the likelihood depends on the grade of reflux, the child's age, and other contributing factors. This page explains how resolution happens, in which children it is more likely, and what 'active surveillance' means.
Vesicoureteral Reflux (VUR) topic clustersMain treatment page →
Basics 6Diagnosis and evaluation 6By age and special situations 5Bladder and bowel 5Treatment pathways 10Kidney health and infection 5After treatment and follow-up 6
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