# VUR — Vesicoureteral reflux grading

> Grades vesicoureteral reflux on voiding cystourethrography.

**Situação:** vigente · **Órgão:** Rim · **Órgão emissor:** International Reflux Study Committee · **Versão:** 1985 · **Ano:** 1985

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: Fluoroscopy
- Fonte primária: Lebowitz RL, Olbing H, Parkkulainen KV, et al.. International system of radiographic grading of vesicoureteric reflux (1985) — https://doi.org/10.1007/BF02388714
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Grade I | Reflux into a non-dilated ureter only (urine refluxes solely into the ureter, which is not dilated). | Lowest-risk grade: conservative observation with the goal of keeping urine sterile; continuous antibiotic prophylaxis individualized/selective (e.g. infants or recurrent febrile UTI) rather than routine, given high spontaneous-resolution rates. | High spontaneous resolution: about 75% (range 70-80%) of grade I-II VUR resolves spontaneously by age 5. | NBK563262 ('about 75% (70% to 80%) of children with grade I and II VUR will spontaneously resolve ... by age 5'); corroborated by en.wikipedia Vesicoureteral_reflux 'Severity'. | ✓ |
| II | Grade II | Reflux reaching the renal pelvis and calyces (ureter and pelvis) without dilatation. | Conservative/low-grade approach: observation with sterile-urine maintenance; antibiotic prophylaxis individualized rather than uniformly applied. | Favorable: about 75% (range 70-80%) of grade I-II VUR resolves spontaneously by age 5. | NBK563262 ('about 75% (70% to 80%) of children with grade I and II VUR will spontaneously resolve ... by age 5'). | ✓ |
| III | Grade III | Mild-to-moderate dilatation of the ureter and pyelocalyceal system with only mild/minimal blunting of the calyceal fornices. | Lower end of 'high-grade': continuous antibiotic prophylaxis is generally recommended; endoscopic subureteric injection considered if intervention is needed and breakthrough infections occur. | Moderate resolution: grade III-IV resolves spontaneously in roughly 60-70% over 5 years when reflux is unilateral and detected before age 2. | NBK563262 (grade III = mildly dilated ureter/pelvocalyceal system, minimal calyceal blunting; 'for grades III and IV ... VUR will resolve in 60% to 70% over 5 years' if unilateral and found before age 2; prophylaxis, endoscopic injection). | ✓ |
| IV | Grade IV | Moderately tortuous, mildly-to-moderately dilated ureter with dilatation of the renal pelvis and calyces and blunting of the calyces, while the papillary impressions are still visible. | High-grade: antibiotic prophylaxis typically recommended; surgical correction (ureteral reimplantation, ~98-99% success) or endoscopic injection (~59% success) for recurrent/breakthrough infection or non-resolution. | Lower spontaneous resolution (grade III-IV ~60-70% over 5 years only if unilateral and detected before age 2); open/robotic reimplantation is highly successful (~98-99%), while endoscopic injection succeeds in ~59%. | NBK563262 (grade IV = tortuous moderately dilated ureter, calyceal blunting with preserved papillary impression; grade III-IV 60-70% over 5 yr if unilateral/early; reimplantation 98-99%, endoscopic grade IV 59%). | ✓ |
| V | Grade V | Severely (grossly) dilated, very tortuous ureter with marked pyelocalyceal dilatation and loss of the papillary impressions/fornices. | Highest-grade: surgical intervention (open ureteral reimplantation) is usually preferred; antibiotic prophylaxis for very young infants pending repair; endoscopic injection an alternative (~62% success). | Spontaneous resolution without surgery is rare; open/robotic reimplantation success is around 80% (lower than the 98-99% seen in lower grades), while endoscopic injection succeeds in ~62%. | NBK563262 (grade V = grossly dilated tortuous ureter, loss of papillary impressions; 'spontaneous resolution without surgical intervention is rare'; reimplantation ~80%, endoscopic 62%). | ✓ |

### Citações por categoria
- **I**: Lebowitz RL, Olbing H, Parkkulainen KV, et al.. International system of radiographic grading of vesicoureteric reflux (1985) — https://doi.org/10.1007/BF02388714 · NBK563262 ('about 75% (70% to 80%) of children with grade I and II VUR will spontaneously resolve ... by age 5'); corroborated by en.wikipedia Vesicoureteral_reflux 'Severity'.
- **II**: Lebowitz RL, Olbing H, Parkkulainen KV, et al.. International system of radiographic grading of vesicoureteric reflux (1985) — https://doi.org/10.1007/BF02388714 · NBK563262 ('about 75% (70% to 80%) of children with grade I and II VUR will spontaneously resolve ... by age 5').
- **III**: Lebowitz RL, Olbing H, Parkkulainen KV, et al.. International system of radiographic grading of vesicoureteric reflux (1985) — https://doi.org/10.1007/BF02388714 · NBK563262 (grade III = mildly dilated ureter/pelvocalyceal system, minimal calyceal blunting; 'for grades III and IV ... VUR will resolve in 60% to 70% over 5 years' if unilateral and found before age 2; prophylaxis, endoscopic injection).
- **IV**: Lebowitz RL, Olbing H, Parkkulainen KV, et al.. International system of radiographic grading of vesicoureteric reflux (1985) — https://doi.org/10.1007/BF02388714 · NBK563262 (grade IV = tortuous moderately dilated ureter, calyceal blunting with preserved papillary impression; grade III-IV 60-70% over 5 yr if unilateral/early; reimplantation 98-99%, endoscopic grade IV 59%).
- **V**: Lebowitz RL, Olbing H, Parkkulainen KV, et al.. International system of radiographic grading of vesicoureteric reflux (1985) — https://doi.org/10.1007/BF02388714 · NBK563262 (grade V = grossly dilated tortuous ureter, loss of papillary impressions; 'spontaneous resolution without surgical intervention is rare'; reimplantation ~80%, endoscopic 62%).


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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