Screening asymptomatic siblings for vesicoureteral reflux: sound science or religious rhetoric?

Many urologists endorse the concept of screening asymptomatic siblings of children known to have vesicoureteral reflux. Others oppose screening until there is better evidence to justify the cost and potential morbidity of adopting a widespread screening program.

A literature review of the following topics was carried out: 1) screening programs in general; 2) reflux in general; 3) familial reflux; and 4) screening for familial reflux.

The evidence supporting our traditional surgical and medical management strategies for reflux is weak. The evidence supporting screening is lacking. Public Health organizations do not address the issue of screening for this condition. Despite this, there is a significant body of peer reviewed literature and compelling expert opinion, in support of screening. Possible reasons for this are explored.

A randomized controlled trial to definitively assess the utility of screening would be larger and more challenging to perform than any ever done in the history of this condition. Until such time that high quality evidence exists, screening of asymptomatic siblings will continue to be based upon our individual clinical experience and teachings, the morbidity of the index case, and socioeconomic factors. We must continue to re-evaluate our management strategies for this condition in light of new information as it accrues.