Management of vesicoureteral reflux in children

Abstract

Background. Vesicoureteral reflux (VUR) in children has been reported in many studies. However, the management of VUR is still controversial.

Methods. One hundred and fourteen children with primary VUR were divided into two treatment groups: medical (group A) and surgical (group B). The clinical courses and X-ray films of cystography and intravenous pyelography of these children were reviewed retrospectively, using the International Reflux Study Committee Classification.

Results. In children less than 1 year of age, VUR was observed more frequently in boys. However, this ratio was reversed in children aged 2 years or more. Sixty-three percent of all refluxing ureters had reflux of grade III or higher at the initial examination. Spontaneous cessation of VUR was observed in 17% of group A ureters, and all had grade III or less reflux. Renal parenchymal scars were already present at the initial examination in 23% of kidneys with refluxing ureters. Recurrent urinary tract infections became less frequent after anti-reflux surgery. The progression of renal scars and renal growth retardation was observed more frequently in group B children.

Conclusions. From these observations, it appeared that surgical management of VUR did not prevent the progression of renal scarring or renal growth retardation. Early detection of and intervention in VUR may prevent the progression of renal scarring and renal growth retardation. However, a multicenter, prospective, randomized controlled study would be necessary to confirm these findings.