In a child with grade III-IV VUR who has a second febrile UTI while on antibiotic prophylaxis, do you move to surgical correction or continue medical management?

A few pieces of info that might impact the recommendation would be the child's age and the child's gender. I assume unilateral reflux since the question didn't specify bilateral. Generically, I counsel families that if a child gets a febrile UTI despite being on ppx and taking the medicine daily as ...

The data show that the grades of reflux that are at the highest risk of scarring are grades IV and V. Grade III is also at high risk. The Swedish studies have shown that antibiotic prophylaxis can help prevent scarring by reducing the risk of urinary tract infections.

Reflux by itself does not cause...

A second febrile UTI on ppx does not mandate surgical correction. Many factors go into whether surgery is ultimately recommended. In the example patient, I would ask about bowel and bladder habits (if male, circumcision status or phimosis). If anything can be optimized medically, I would first work ...