A number of trials have been conducted or are under way to determine optimal approaches to the assessment and management of initial febrile urinary tract infections and subsequent interventions for them. This review summarises the diverse views on this controversial topic under the following topics:

• Background

• Long-term consequences

• Pathophysiology of pyelonephritis and scar formation

• Treatment of an acute episode

• Interventions after urinary tract infection: antibiotic prophylaxis, surgical correction of vesicoureteral reflux, adjunctive treatments

• Imaging after a first febrile urinary tract infection