Treatment of vesicoureteral reflux: point system based on 20 years of experience

During the last 20 years 500 girls with recurrent urinary tract infection and documented reflux were seen in private practice. All patients received medical treatment for 3 to 48 months (an average of 15 months) after which the 250 who were not cured underwent a corrective operation. The primary reason for an antireflux operation is to protect the kidney from the damaging effect of a combination of high pressure and infection. Thus, the criteria for operation included persistent infection, renal changes typical of previous pyelonephritis, major reflux and abdominal or flank pain. The surgical cure rate after careful long-term followup approaches 98%. The medical cure rate at the end of 2 years reached 88%. This experience has enabled the establishment of a rigorous point system, providing common denominators regarding indications for operation. It emphasizes the desirability of attempting a medical cure for at least 1 year after urethral dilatation, except when major orifice defects and major reflux exist. This system should help to increase communication and coordination of efforts among the pediatrician, radiologist and urologist.