CONTROL STUDY OF MEDICAL (M) VERSUS SURGICAL (S) TREATMENT OF VESICOURETERAL REFLUX (VUR)

The purpose of this prospective study is to determine whether renal scars may be prevented in children with VUR by either a strict M treatment program or by S treatment (ureteral reimplantation) combined with a M program. Patients(pts) age 2 months to 12 years were admitted to the study after voiding cystourethrogram(VCUG) showed VUR grade 2a or greater regardless of the presence or absence of renal scars on excretory urogram(EU). After classification according to age and grade of VUR pts were assigned by randomization to the M or S regimen. All pts were treated prophylactically with Septra(Str)(lmg TMP, 5mg SMX/lb) or Macrodantin(Mcd)(lmg/lb) nightly. Pts with 2a VUR were assigned only to the M program and did not undergo cystoscopy. Urine cultures were done monthly for 6 months then every 2 months, nitrite tests at 2-4 week intervals at home on overnight specimens, CBC, BUN, creatinine, SGOT at the beginning of study and at regular intervals. 33 pts have now been followed for a total of 277 months. Only 3 pts had a positive urine culture, 2 on Str and 1 on Mcd prophylaxis. Follow-up VCUGs of pts on M treatment have shown no change in 4, ↓ grade of VUR in 2 and no VUR in 3. Follow-up EU show no change in 4, (2 on S protocol), ↓ calyceal abnormalities with ↑ growth in 1. Blood tests remain normal. Although S cures VUR, children on a strict M protocol maintain a sterile urine, show ↓ VUR, ↓ renal abnormalities and ↑ growth of affected kidneys. Supported by Burroughs Wellcome Co. grant.