Vesicoureteral reflux update: effect of prospective studies on current management.

Until recemly, management decisions regarding vesicoureteral reflux (VUR) were based on a combination of bias and scattered objective data. These data provided some information about the natural history and pathogenesis of reflux but little as 1.0 whether medical or surgical treatment was the most advantageous. Management of VUR has been based on a series of premises. These include the following: VUR disappears spontaneously in many infants and young children but if still present at puberty is much less likely to resolve’- ‘; spontaneous resolution is lessened by severe grade of VUR, but can still occur even when associated with anomalies such as duplex ureter and paraureteral diverticulumJx5; sterile VUR does not appear to cause reflux nephropathy (RN), although it may be associated with minimal abnormalities of function such as alterations in concentrating ability.h,7 An exception to this may be that patients with sterile VUR and dysfunctional voiding with elevated bladder pressure have the potential for development of hydronephrosis and its associated effects on the renal parenchyma. Longterm antibacterials are well tolerated by children”; and surgical procedures to eliminate reflux are quite effective and indeed have traditionally set a standard against which medical management is measured.“~” Within the past decade four prospective studies have yielded data that provide a measure of how accurate our biases have been. These are the Birmingham Reflux Study, iL the Reflux study of the Southwest Pediatric Nephrology Group,13 and the American and European arms of the International Reflux Stud):”