Medical management is recommended in children with Grade I-III VUR as most cases will resolve spontaneously. A trial of medical treatment is indicated in patients with Grade IV VUR especially in younger patients or those with unilateral disease. Of the patients with Grade V VUR only infants are trialled on a medical approach before surgery is indicated, in older patients surgery is the only option. Endoscopic injection
Endoscopic injection involves applying a gel around the ureteral opening to create a valve function and stop urine from flowing back up the ureter. The gel consists of two types of sugar-based molecules called dextranomer and hyaluronic acid. Trade names for this combination include Deflux and Zuidex. Both constituents are well known from previous uses in medicine. They are also biocompatible, which means that they do not cause significant reactions within the body. In fact, hyaluronic acid is produced and found naturally within the body. Medical treatment
Medical treatment entails low dose antibiotic prophylaxis until resolution of VUR occurs. Antibiotics are administered nightly at half the normal therapeutic dose. The specific antibiotics used differ with the age of the patient and include:

Amoxicillin or ampicillin – infants younger than 6 weeks
Trimethoprim-sulfamethoxazole (co-trimoxazole) – 6 weeks to 2 monthsAfter 2 months the following antibiotics are suitable:

Nitrofurantoin {5–7 mg/kg/24hrs}
Nalidixic acid
Bactrim
Trimethoprim
CephalosporinsUrine cultures are performed 3 monthly to exclude breakthrough infection. Annual radiological investigations are likewise indicated. Good perineal hygiene, and timed and double voiding are also important aspects of medical treatment. Bladder dysfunction is treated with the administration of anticholinergics.
First-degree atrioventricular block
First-degree AV block occurs when there is a delay, but not disruption, as the electrical signal moves between the atrium and the ventricles through the AV node. On ECG, this is defined by a PR interval greater than 200 msec. Additionally, there are no dropped, or skipped, beats. Second-degree atrioventricular block
Second-degree AV block occurs when the electrical signal between the atria and ventricles is even more impaired than in a first-degree AV block. In a second-degree AV block, the impairment results in a failure to conduct an impulse, which causes a skipped beat. Mobitz I
Mobitz I is characterized by a progressive yet reversible block of the AV node. On ECG, this is defined by progressive prolongation of the PR interval, with a resulting dropped beat (the PR interval gets longer and longer until a beat is finally dropped, or skipped).Some patients are asymptomatic; those who have symptoms respond to treatment effectively. There is a low risk of a Mobitz I AV block leading to heart attack and complete heart block. Mobitz II
Mobitz II is caused by a sudden, unexpected failure of the His-Purkinje cells to conduct the electrical impulse. On ECG, the PR interval is unchanged from beat to beat, but there is a sudden failure to conduct the signal to the ventricles, and resulting in random skipped beat.The risks and possible effects of Mobitz II are much more severe than Mobitz I in that it can lead to severe heart attack.