Commentary to ''Controversies in the management of vesicoureteral reflux e The rationale for the RIVUR study''

This review article addresses the question of which is the best treatment for VUR: is it long-term prophylactic antibiotics, short-term antibiotics or surgical treatment? Most of the studies referred to, as well as the planned RIVUR study, have considered the first two treatment options, and there appears to be no difference in outcome regarding incidence of febrile UTI or renal scars. One must accept that prophylactic antibiotic treatment may promote the development of antibiotic resistance and it has also been shown to be ineffective in preventing UTIs [1]. Short-term antibiotic therapy has its risks as patients must be followed carefully, and new febrile UTIs must to be treated without delay when new infections emerge. We know today that VUR is a strong risk factor for febrile UTIs and that treatment of VUR reduces the risk of pyelonephritis [2]. The open surgical procedure of ureteral reimplantation of the refluxing ureter has been shown to decrease the risk for febrile UTIs [2]. Endoscopic treatment has also been shown to afford good long-term results in preventing pyelonephritis in patients followed for 7e12 years after treatment, with a UTI incidence of 3.4% [3]. In a shorter follow-up study, only 1% of patients with endoscopically corrected reflux had proven pyelonephritis [4], and in the study by Wadie et al. [5] the mean incidence of UTIs fell five-fold after endoscopic treatment. These data should be compared to the incidence of UTIs on prophylactic treatment (21%) and after open surgery