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Updated: May 1, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
[Primary vesicoureteral reflux: conservative therapy or surgical intervention]
Camila Borges Bezerra Teixeira1, Maria Aparecida de Paula Cançado1, João Tomás de Abreu Carvalhaes1
1Escola Paulista de Medicina, Universidade Federal de Sao Paulo.
Insights
Pediatric vesicoureteral reflux (VUR) often resolves spontaneously with conservative management, especially in low-grade cases. Surgical intervention is typically reserved for high-grade VUR or complex clinical scenarios to prevent renal damage.
Area of Science:
- Pediatric Nephrology
- Urology
- Pediatric Surgery
Background:
- Urinary tract infections (UTIs) in children can lead to renal damage if associated with primary vesicoureteral reflux (VUR).
- Literature indicates increasing rates of spontaneous VUR resolution and a decrease in surgical interventions for this condition.
Purpose of the Study:
- To investigate the natural history of primary VUR in children with recurrent UTIs.
- To compare outcomes of conservative versus surgical management for VUR.
- To identify factors influencing VUR resolution and the need for intervention.
Main Methods:
- Retrospective analysis of patient records from a Pediatric Nephrology department.
- Data collected included patient demographics, UTI history, VUR grade, renal function, renal scarring, and treatment type (conservative vs. surgical).
- Descriptive statistical analysis was performed using SPSS software.
Main Results:
- High-grade VUR (IV-V) and bilateral VUR were associated with higher rates of surgical intervention (63.6% and 72.7%, respectively).
- Low-grade VUR (I-III) showed a higher tendency towards conservative management (61.5%).
- No correlation was found between VUR grade and the presence of renal scarring.
Conclusions:
- Low-grade VUR in children with recurrent UTIs often resolves spontaneously, leading to favorable long-term renal outcomes with conservative therapy.
- Surgical intervention for VUR should be primarily considered for high-grade cases or when complicated by other clinical factors.
- Conservative management is effective for many pediatric VUR cases, limiting the need for surgery.
Introduction:
The relationship between urinary tract infections and primary vesicoureteral reflux may lead to permanent renal damage. In the literature an increasing number of spontaneous cure of vesicoureteral reflux in children and the significant decrease in surgical therapy has been observed.
Objective:
To study the evolution of primary vesicoureteral reflux associated with recurring urinary tract infections settings in patients of the Pediatric Nephrology department of our institution, evaluating cases in which cure was achieved through conservative therapy only and those in which surgical intervention was required.
Methods:
We analyzed records and collected data refers to parameters: sex, age upon the diagnosis of primary urinary infection, age upon diagnosis of vesicoureteral reflux, number of urinary tract infections, vesicoureteral reflux grade; renal function, renal scaring, other malformation of urinary tract, and surgical or conservative intervention. Statistical analysis was descriptive and conducted with the SPSS program.
Results:
Within the subgroup of patients with grade IV and V, 63.6% of the cases evolved to surgical intervention and 36.4% to conservative intervention. In those with grades I, II, and III, 38.5% evolved to surgical treatment against 61.5% for conservative approach. Among those with bilateral vesicoureteral reflux, 72.7% had to undergo surgical intervention. No relationship was observed between the vesicoureteral reflux grade and the presence of renal scaring.
Conclusion:
Patients with low grade vesicoureteral reflux and recurring urinary tract infections tend to experience spontaneous reflux resolution with good renal evolution in the long term in a way that surgical intervention becomes limited to high grade reflux or when followed by other clinical issues.
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